Healthcare Provider Details

I. General information

NPI: 1275573743
Provider Name (Legal Business Name): JOHN E LATTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 W HERNDON AVE
FRESNO CA
93722-8402
US

IV. Provider business mailing address

4770 W HERNDON AVE
FRESNO CA
93722-8402
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-6365
  • Fax: 559-271-6326
Mailing address:
  • Phone: 559-271-6365
  • Fax: 559-271-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA18756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: