Individual
LATUAVIA BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2303 AVENUE H, GRAND PRAIRIE, TX 75050-2789
(469) 883-9216
Mailing address
2303 AVENUE H, GRAND PRAIRIE, TX 75050-2789
(469) 883-9216
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
1478578
TX
Other
Enumeration date
07/17/2022
Last updated
07/17/2022
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