Provider Demographics
NPI:1316720337
Name:MOORE-GALBERTH, LATONIA R (CM)
Entity type:Individual
Prefix:
First Name:LATONIA
Middle Name:R
Last Name:MOORE-GALBERTH
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4724 GINA PL
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3924
Mailing Address - Country:US
Mailing Address - Phone:405-301-3475
Mailing Address - Fax:
Practice Address - Street 1:5505 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-5508
Practice Address - Country:US
Practice Address - Phone:405-606-6595
Practice Address - Fax:105-609-6575
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator