Individual
LATONYA PATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4334 N 63RD AVE, PHOENIX, AZ 85033-2701
(623) 846-0673
Mailing address
4334 N 63RD AVE, PHOENIX, AZ 85033-2701
(623) 846-0673
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10462
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
985351
AHCCCS ID
AZ
Enumeration date
11/29/2006
Last updated
07/08/2007
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