1841420221 NPI number — MS. LATHOSHA ALEXANDER

Table of content: MS. LATHOSHA ALEXANDER (NPI 1841420221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841420221 NPI number — MS. LATHOSHA ALEXANDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
LATHOSHA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841420221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 NW 167TH ST
Provider Second Line Business Mailing Address:
SUITE #102
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33056-4838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-624-7450
Provider Business Mailing Address Fax Number:
305-623-7893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13681 SW 51ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33027-5919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-624-7450
Provider Business Practice Location Address Fax Number:
305-623-7893
Provider Enumeration Date:
07/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW14731 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)