Provider Demographics
NPI:1528472420
Name:POWELL, LATOYA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL LEMOORE
Mailing Address - Street 2:937 FRANKLIN AVENUE
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93246-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL LEMOORE
Practice Address - Street 2:937 FRANKLIN AVENUE
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93246-5004
Practice Address - Country:US
Practice Address - Phone:559-998-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman