Individual
STACY ANN LATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
17323 CAMPILLO DR, SAN DIEGO, CA 92128-2149
(858) 485-0848
Mailing address
17323 CAMPILLO DR, SAN DIEGO, CA 92128-2149
(185) 848-5084
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 1715
CA
Other
Enumeration date
02/15/2011
Last updated
02/15/2011
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