Healthcare Provider Details

I. General information

NPI: 1184755860
Provider Name (Legal Business Name): JAMES ROBERT LATTA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N LA BREA AVE SUITE 700
INGLEWOOD CA
90301-1752
US

IV. Provider business mailing address

111 N LA BREA AVE SUITE 700
INGLEWOOD CA
90301-1752
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-7808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS16902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: