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General NPI Number Information
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NPI Number | 1528196326
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Entity Type | Individual
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Provider Name | GRACE G LAT M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6599 FOOTHILL BLVD.
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City | OAKLAND
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State | CA
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Zip | 94605
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Country | US
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Telephone | 510-567-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 2709 CHERRY BLOSSOM WAY
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City | UNION CITY
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State | CA
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Zip | 94587-4911
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Country | US
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Telephone | 510-429-0933
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Fax | 510-429-0960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | A5590
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License Number State | CA
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