Provider Demographics
NPI:1326378373
Name:IRA S LATTO M D MEDICAL COPORATION
Entity Type:Organization
Organization Name:IRA S LATTO M D MEDICAL COPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:LATTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-782-6841
Mailing Address - Street 1:6850 SEPULVEDA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4465
Mailing Address - Country:US
Mailing Address - Phone:818-782-6841
Mailing Address - Fax:818-782-3553
Practice Address - Street 1:6850 SEPULVEDA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4465
Practice Address - Country:US
Practice Address - Phone:818-782-6841
Practice Address - Fax:818-782-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255417705Medicare PIN