Healthcare Provider Details

I. General information

NPI: 1730496902
Provider Name (Legal Business Name): DONALD BRANUM LATHROP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 KNOLL DR
LOS ALTOS CA
94024-4731
US

IV. Provider business mailing address

472 KNOLL DR
LOS ALTOS CA
94024-4731
US

V. Phone/Fax

Practice location:
  • Phone: 650-949-3353
  • Fax:
Mailing address:
  • Phone: 650-949-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCFE23960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: