Provider Demographics
NPI:1912793076
Name:TOWNSEND, LATONYA
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 S TIPPECANOE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2607
Mailing Address - Country:US
Mailing Address - Phone:909-723-1695
Mailing Address - Fax:
Practice Address - Street 1:696 S TIPPECANOE AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2607
Practice Address - Country:US
Practice Address - Phone:909-723-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker