Provider Demographics
NPI:1356141741
Name:MAHONE, LATASHA K
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:K
Last Name:MAHONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2207
Mailing Address - Country:US
Mailing Address - Phone:330-881-0455
Mailing Address - Fax:
Practice Address - Street 1:3261 HERMOSA DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2207
Practice Address - Country:US
Practice Address - Phone:330-881-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRW233114261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service