Provider Demographics
NPI:1255417705
Name:LATTO, IRA S (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:S
Last Name:LATTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14914 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2113
Mailing Address - Country:US
Mailing Address - Phone:818-787-2020
Mailing Address - Fax:818-787-8652
Practice Address - Street 1:14914 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2113
Practice Address - Country:US
Practice Address - Phone:818-787-2020
Practice Address - Fax:818-787-8652
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG12260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G122600Medicaid
CA0879070001Medicare NSC
CAA90196Medicare UPIN
CA00G122600Medicaid