Provider Demographics
NPI:1124773775
Name:LATORTUE, EDOUARD ANTONIO
Entity type:Individual
Prefix:
First Name:EDOUARD
Middle Name:ANTONIO
Last Name:LATORTUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 ELMWOOD AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1579
Mailing Address - Country:US
Mailing Address - Phone:401-688-4105
Mailing Address - Fax:
Practice Address - Street 1:319 ELMWOOD AVE APT 4C
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1579
Practice Address - Country:US
Practice Address - Phone:401-688-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula