Provider Demographics
NPI:1619965506
Name:LATIF, ALAA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAA
Middle Name:
Last Name:LATIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ROYALTY DR STE 140
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3044
Mailing Address - Country:US
Mailing Address - Phone:909-620-0200
Mailing Address - Fax:909-620-0220
Practice Address - Street 1:1910 ROYALTY DRIVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5176
Practice Address - Country:US
Practice Address - Phone:909-630-7290
Practice Address - Fax:909-630-7299
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A519552Medicaid
WA51955HOtherMEDICARE PTAN
CAF90570Medicare UPIN