Provider Demographics
NPI:1689497943
Name:LATHA ACHANTA MD INC
Entity type:Organization
Organization Name:LATHA ACHANTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-901-3087
Mailing Address - Street 1:2105 FOOTHILL BLVD STE B262
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 E GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5159
Practice Address - Country:US
Practice Address - Phone:626-963-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty