Individual
KUSUM LATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1801 E MARCH LN, #A-170, STOCKTON, CA 95210-6629
(209) 951-9885
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A 110487
CA
207RC0000X
Cardiovascular Disease Physician
Primary
A110487
CA
Other
Enumeration date
01/20/2010
Last updated
09/01/2016
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