Provider Demographics
NPI:1770307340
Name:TAYLOR, LATANDRA L
Entity type:Individual
Prefix:MRS
First Name:LATANDRA
Middle Name:L
Last Name:TAYLOR
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 1:8614 CRESCENT VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3734
Mailing Address - Country:US
Mailing Address - Phone:281-716-7670
Mailing Address - Fax:
Practice Address - Street 1:6201 BONHOMME RD STE 266N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4375
Practice Address - Country:US
Practice Address - Phone:832-862-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker