Individual
LATARSHA WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
84 WELLES AVE, DORCHESTER, MA 02124-2444
(617) 436-8400
Mailing address
337 ADAMS ST, DORCHESTER, MA 02122-1232
(617) 436-8400
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
58895
MA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
58895
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58895
MA STATE COCOSMETOLOGY LICENSE NUMBER
MA
Enumeration date
12/27/2017
Last updated
06/16/2018
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