Provider Demographics
NPI:1437374188
Name:SHEIKH A. LATIF DO A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHEIKH A. LATIF DO A PROFESSIONAL CORPORATION
Other - Org Name:DBA VALLEY ENDOVASCULAR INSTITUTE OF SURGERY DBA CALSTATESURGEONS, P.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIEZL 'LIZ'
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDILAS-LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-239-5449
Mailing Address - Street 1:1524 W. LACEY BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:877-360-8346
Mailing Address - Fax:877-360-8346
Practice Address - Street 1:1524 W. LACEY BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:877-360-8346
Practice Address - Fax:877-360-8346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEIKH A LATIF DO A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9229208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX92291Medicaid
CA00AX92291Medicaid
CA144734Medicare UPIN
I44734Medicare UPIN