Individual provider · NPI-1

Lateisha Mcdonald, CEO

Registered Nurse, Hospice · Colton, CA

NPI number1720694524
StatusActive
Last updated in NPPESSep 17, 2020

Details

NPI
1720694524
Entity type
Individual (NPI-1)
Name
Lateisha Mcdonald
Credential
CEO
Sex
Female
Sole proprietor
No
Enumeration date
Sep 17, 2020
Certification date
Sep 17, 2020
Last updated
Sep 17, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WH1000X Registered Nurse, Hospice123708CAYes

Practice location

1003 E Cooley Dr Ste J
Colton, CA 92324-3948

Phone 951-992-3665

Mailing address

1003 E Cooley Dr Ste J
Colton, CA 92324-3948

Phone 951-992-3665

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