MEDICARE: MITCHELL CURTIS LATTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G40013	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255411625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL CURTIS LATTER MD

Provider Business Mailing Address
First Line	:	1499 HUNTINGTON DR STE 508
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5464
Country	:	US
Telephone Number	:	626-799-9588
Fax Number	:	626-799-9338

Provider Business Practice Location Address
First Line	:	1499 HUNTINGTON DR STE 508
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5464
Country	:	US
Telephone Number	:	626-799-9588
Fax Number	:	626-799-9339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	09/14/2023

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