Individual
VIVIAN LATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-3939
Mailing address
8268 164 ST, JAMAICA, NY 11432
(718) 883-3939
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
F350171
NY
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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