Provider Demographics
NPI:1285908152
Name:TITTLE, LATASHIA RENE (NP)
Entity type:Individual
Prefix:MS
First Name:LATASHIA
Middle Name:RENE
Last Name:TITTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S POINSETTIA AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3341
Mailing Address - Country:US
Mailing Address - Phone:310-438-3110
Mailing Address - Fax:310-438-3110
Practice Address - Street 1:212 S POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3341
Practice Address - Country:US
Practice Address - Phone:310-438-3110
Practice Address - Fax:310-438-3110
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623775261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty