Provider Demographics
NPI:1629245238
Name:LATTYAK, BRUCE V (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:V
Last Name:LATTYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 SIERRA COLLEGE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5086
Mailing Address - Country:US
Mailing Address - Phone:530-273-3400
Mailing Address - Fax:530-274-3400
Practice Address - Street 1:300 SIERRA COLLEGE DR STE 240
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5086
Practice Address - Country:US
Practice Address - Phone:530-273-3400
Practice Address - Fax:530-274-3400
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2019-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA62583208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery