Provider Demographics
NPI:1083628002
Name:LATTA, VIRGINIA (NP, RN)
Entity Type:Individual
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First Name:VIRGINIA
Middle Name:
Last Name:LATTA
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Gender:F
Credentials:NP, RN
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Mailing Address - Street 1:350 POSADA LN
Mailing Address - Street 2:#102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4059
Mailing Address - Country:US
Mailing Address - Phone:805-434-3699
Mailing Address - Fax:805-434-4864
Practice Address - Street 1:350 POSADA LN
Practice Address - Street 2:102
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4059
Practice Address - Country:US
Practice Address - Phone:805-434-3699
Practice Address - Fax:805-434-4864
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA153772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA153772Medicaid
CA153772Medicaid