Provider Demographics
NPI:1013407840
Name:SOLOMON, LATAVA
Entity type:Individual
Prefix:
First Name:LATAVA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24225 W 9 MILE RD # 8
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3962
Mailing Address - Country:US
Mailing Address - Phone:313-742-4108
Mailing Address - Fax:
Practice Address - Street 1:19752 HARTWELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1172
Practice Address - Country:US
Practice Address - Phone:313-742-4108
Practice Address - Fax:313-742-4108
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2025-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703119529164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse