Provider Demographics
NPI:1639118359
Name:ALLEN, LATRICE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LATRICE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4871
Mailing Address - Country:US
Mailing Address - Phone:310-539-5060
Mailing Address - Fax:310-539-7899
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:STE 240
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4871
Practice Address - Country:US
Practice Address - Phone:310-539-5060
Practice Address - Fax:310-539-7899
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA63978207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA63978Medicare PIN
CAH28533Medicare UPIN