Most Relevant Information
Provider Data
| NPI Number: | 1003591330 |
| Provider Name: | JUSTIN JEFFREY LAT |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/15/2023 |
| Last Updated: | 12/12/2023 |
Provider Practice Location
265 S ANITA DR STE 102-104
ORANGE
CA
928683355
Practice Location Phone/Fax
| Phone: | 3109453350 |
| Fax: |
Provider Mailing Location
9808 VENICE BLVD STE 505
CULVER CITY
CA
902326818
Provider Mailing Phone/Fax
| Phone: | 3109453350 |
| Fax: |