MEDICARE: DR. CYNTHIA LATHAM MACER M.D.

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	208D00000X	General Practice Physician	G67152	CA

General Provider Information

NPI Number	:	1659423374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA LATHAM MACER M.D.

Provider Business Mailing Address
First Line	:	550 DEEP VALLEY DR
Second Line	:	STE 287
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-7600
Country	:	US
Telephone Number	:	310-541-8400
Fax Number	:	310-541-7900

Provider Business Practice Location Address
First Line	:	827 DEEP VALLEY DR
Second Line	:	SUITE 207
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3647
Country	:	US
Telephone Number	:	310-541-8400
Fax Number	:	310-541-7900

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	01/24/2017

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