Provider Demographics
NPI:1194884171
Name:HINES, LATANYA RENEE (MD)
Entity type:Individual
Prefix:MRS
First Name:LATANYA
Middle Name:RENEE
Last Name:HINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LATANYA
Other - Middle Name:RENEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6033 S GARTH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1515
Mailing Address - Country:US
Mailing Address - Phone:310-645-5045
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE STE 202
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:626-793-5250
Practice Address - Fax:626-793-5260
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist