Provider Demographics
NPI:1396863684
Name:MITCHELL C LATTER M D INC A PROF CORP
Entity Type:Organization
Organization Name:MITCHELL C LATTER M D INC A PROF CORP
Other - Org Name:MITCHELL C LATTER MD INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:LATTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-920-8829
Mailing Address - Street 1:10230 ARTESIA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6763
Mailing Address - Country:US
Mailing Address - Phone:562-920-8829
Mailing Address - Fax:562-920-1305
Practice Address - Street 1:10230 ARTESIA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6763
Practice Address - Country:US
Practice Address - Phone:562-920-8829
Practice Address - Fax:562-920-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40013332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G400130Medicaid
CAB56712Medicare UPIN
CAG40013Medicare ID - Type Unspecified
CA00G400130Medicaid