Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 1870781 | NY |
NPI | 1073508933 |
---|---|
Provider Name | Mr. Sebastian Lattuga |
First Address | Lake Success, NY 11042-1011 |
Second Address | Lake Success, NY 11042-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q38923 | (02) |