Individual
LATASIA MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18968 W MONROE ST, BUCKEYE, AZ 85326-5727
(602) 483-3957
Mailing address
18968 W MONROE ST, BUCKEYE, AZ 85326-5727
(602) 483-3957
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH6936
AZ
Other
Enumeration date
08/30/2021
Last updated
08/31/2021
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