Provider Demographics
NPI:1386135895
Name:LATA, MANUEL MIRANDA JR (RN)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:MIRANDA
Last Name:LATA
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:6400 SOUTHCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2547
Mailing Address - Country:US
Mailing Address - Phone:206-901-2000
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:505 29TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7541
Practice Address - Country:US
Practice Address - Phone:253-876-7650
Practice Address - Fax:206-302-2210
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN60680518163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health