Provider Demographics
NPI:1255411625
Name:LATTER, MITCHELL CURTIS (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:CURTIS
Last Name:LATTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 HUNTINGTON DR STE 508
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5464
Mailing Address - Country:US
Mailing Address - Phone:626-799-9588
Mailing Address - Fax:626-799-9338
Practice Address - Street 1:1499 HUNTINGTON DR STE 508
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5464
Practice Address - Country:US
Practice Address - Phone:626-799-9588
Practice Address - Fax:626-799-9339
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40013207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G400130Medicaid
B56712Medicare UPIN
CA00G400130Medicaid