Individual
LATORA SUBANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16179 SISKIYOU RD, APPLE VALLEY, CA 92307-1314
(661) 267-6876
Mailing address
3 RUE MONET, FOOTHILL RANCH, CA 92610-2482
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
95005753
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
95005753
CA
Other
Enumeration date
06/18/2017
Last updated
01/20/2025
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