Provider Demographics
NPI:1609929934
Name:LAT, MARIA CRISTINA C
Entity Type:Individual
Prefix:DR
First Name:MARIA CRISTINA
Middle Name:C
Last Name:LAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8806
Mailing Address - Country:US
Mailing Address - Phone:562-921-0898
Mailing Address - Fax:562-921-0919
Practice Address - Street 1:13400 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8806
Practice Address - Country:US
Practice Address - Phone:562-921-0898
Practice Address - Fax:562-921-0919
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609929934OtherNPI TYPE 1
CAB41899-01OtherDENTI-CAL PROVIDER NO.
CA1770955684OtherDENTICAL PROVIDER NUMBER
CA41899OtherDENTAL LICENSE
1770955684OtherNPI TYPE 2