Provider Demographics
NPI:1689372120
Name:PARKER, LATOYA ASHLY RENEE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:ASHLY RENEE
Last Name:PARKER
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 1:833 N VINEYARD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3167
Mailing Address - Country:US
Mailing Address - Phone:562-326-4031
Mailing Address - Fax:
Practice Address - Street 1:833 N VINEYARD AVE APT B
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3167
Practice Address - Country:US
Practice Address - Phone:562-326-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician