Provider Demographics
NPI:1730901224
Name:PROCTOR, LATASHA TALITHA (LVN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:TALITHA
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 CANBY AVE STE 456
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3006
Mailing Address - Country:US
Mailing Address - Phone:818-705-5561
Mailing Address - Fax:
Practice Address - Street 1:7232 CANBY AVE STE 456
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3006
Practice Address - Country:US
Practice Address - Phone:818-705-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254088164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty