Individual
ANDREW LATAILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1300 N 12TH ST STE 508, PHOENIX, AZ 85006-2849
(602) 839-3927
Mailing address
1300 N 12TH ST STE 508, PHOENIX, AZ 85006-2849
(602) 839-3927
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/03/2023
Last updated
05/29/2025
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