Individual
LATARA U PORCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3309 PARKMILL DR, KILLEEN, TX 76542-6470
(813) 409-4146
Mailing address
3309 PARKMILL DR, KILLEEN, TX 76542-6470
(813) 409-4146
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1744P3200X
—
TX
Enumeration date
03/05/2019
Last updated
03/05/2019
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