Provider Demographics
NPI:1366013260
Name:RUFFINS, LATANDREA
Entity type:Individual
Prefix:
First Name:LATANDREA
Middle Name:
Last Name:RUFFINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 PINES ROAD
Mailing Address - Street 2:SUITE 1200-E
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3935
Mailing Address - Country:US
Mailing Address - Phone:318-517-7428
Mailing Address - Fax:318-568-8019
Practice Address - Street 1:7505 PINES ROAD
Practice Address - Street 2:SUITE 1200-E
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3935
Practice Address - Country:US
Practice Address - Phone:318-517-7428
Practice Address - Fax:318-568-8019
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA339805246RP1900X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)