Provider Demographics
NPI:1871594903
Name:LATHAM, EMI MISAO (MD)
Entity type:Individual
Prefix:DR
First Name:EMI
Middle Name:MISAO
Last Name:LATHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 SHELTER ISLAND DR STE 105-704
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2743
Mailing Address - Country:US
Mailing Address - Phone:619-663-6698
Mailing Address - Fax:
Practice Address - Street 1:387 N ESCONDIDO BLVD STE A
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2624
Practice Address - Country:US
Practice Address - Phone:760-740-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81406207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A814060Medicaid
CAWA81406CMedicare PIN
H65015Medicare UPIN