Provider Demographics
NPI:1366264152
Name:OWENS, LATASHA RENEE'
Entity type:Individual
Prefix:MS
First Name:LATASHA
Middle Name:RENEE'
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PRECIOUS
Other - Middle Name:RENEE'
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 BAYLEY AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2943
Mailing Address - Country:US
Mailing Address - Phone:347-968-1970
Mailing Address - Fax:
Practice Address - Street 1:39 W 32ND ST RM 1704
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3839
Practice Address - Country:US
Practice Address - Phone:347-968-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYACE-T-22-05651-2247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other