Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | NP16256 | CA |
NPI | 1659536688 |
---|---|
Provider Name | Ms. Latisha L Deyoung |
First Address | Long Beach, CA 90806-1701 |
Second Address | Long Beach, CA 90806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 25/08/2017 |