Basic Information
| Provider Information | |||||||||
| NPI: | 1427340389 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRENDA LATOWSKY M.D. P.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12251 N 32ND ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850327189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029710950 | ||||||||
| FaxNumber: | 6029924971 | ||||||||
| Practice Location | |||||||||
| Address1: | 12251 N 32ND ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850327189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029710950 | ||||||||
| FaxNumber: | 6029924971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | MANNING | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6029710950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | 41903 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
ID Information
| ID | Type | State | Issuer | Description | Z145456 | 01 | AZ | PTAN | OTHER |