Individual
MARQUITA LATORIA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
178 NAUTICO WAY, PORTSMOUTH, VA 23703-5469
(757) 920-9420
(757) 484-7256
Mailing address
178 NAUTICO WAY, PORTSMOUTH, VA 23703-5469
(757) 920-9420
(757) 484-7256
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
46955
VA
Other
Enumeration date
05/02/2019
Last updated
05/02/2019
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