Provider Demographics
NPI:1467668053
Name:LATHER, TUYET T (DO)
Entity Type:Individual
Prefix:DR
First Name:TUYET
Middle Name:T
Last Name:LATHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TUYET
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:3544 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4120
Practice Address - Country:US
Practice Address - Phone:619-515-2424
Practice Address - Fax:619-683-7570
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9180OtherLIC