Individual
LATANYA OLIVIA EDENBURGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10436 E RADIANT AVE., MESA, AZ 85212
(480) 560-2305
Mailing address
10436 E RADIANT AVE, MESA, AZ 85212-8099
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2675131
—
AZ
Enumeration date
11/20/2017
Last updated
11/20/2017
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