Active NPI
Latresa Dewberry
- Contractor
- Mesquite, TX
National Provider Identifier
1659686467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 705 Via Bravo
Mesquite, TX 75150-3017 - Phone
- (469) 879-3396
- Fax
- (214) 613-2592
- NPI assigned
- Aug 17, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Primary |
Addresses
Primary practice location
705 Via Bravo
Mesquite, TX 75150-3017
Mailing address
705 Via Bravo
Mesquite, TX 75150-3017
Phone (469) 879-3396
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282003200000",
"number": "1659686467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 VIA BRAVO",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751503017",
"telephone_number": "469-879-3396",
"fax_number": "214-613-2592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 VIA BRAVO",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751503017",
"telephone_number": "469-879-3396",
"fax_number": "214-613-2592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWBERRY",
"first_name": "LATRESA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-17",
"last_updated": "2010-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.