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General NPI Number Information
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NPI Number | 1356469365
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Entity Type | Organization
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Legal Business Name | MITCHELL C LATTER MD INC A PROF CORP
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 1499 HUNTINGTON DRIVE SUITE 508
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5464
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Country | US
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Telephone | 626-799-9588
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Fax | 626-799-9339
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Provider Business Mailing Address
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Address Line | 1499 HUNTINGTON DRIVE SUITE 508
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5464
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Country | US
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Telephone | 626-799-9588
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Fax | 626-799-9339
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITCHELL CURTIS LATTER
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Credential | MD
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Telephone | 626-799-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | G40013
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License Number State | CA
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