Healthcare Provider Details

I. General information

NPI: 1407959802
Provider Name (Legal Business Name): LATHA SRINATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SOUTH CONGRESS AVE STE 100
BOYNTON BEACH FL
33426
US

IV. Provider business mailing address

2300 SOUTH CONGRESS AVE STE 100
BOYNTON BEACH FL
33426
US

V. Phone/Fax

Practice location:
  • Phone: 561-735-7531
  • Fax: 561-742-8250
Mailing address:
  • Phone: 561-735-7531
  • Fax: 561-742-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0066586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: