Individual
LATESHIA EAGLETAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
222 E MCDOWELL RD, PHOENIX, AZ 85004-1677
(623) 205-1407
Mailing address
222 E MCDOWELL RD, PHOENIX, AZ 85004-1677
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
CLT00171587849666370
AZ
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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