Individual
LATICCO R ROBINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
725 ALBANY STREET, SHAPIRO LOWER LEVEL, BOSTON, MA 02118
(617) 638-6287
(617) 638-6284
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA4874
MA
Other
Enumeration date
10/30/2013
Last updated
03/04/2015
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