Provider Demographics
NPI:1639381619
Name:ALTAMIMI, SADIQ LAFTA (MD)
Entity Type:Individual
Prefix:
First Name:SADIQ
Middle Name:LAFTA
Last Name:ALTAMIMI
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 1:2895 N TOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2009
Mailing Address - Country:US
Mailing Address - Phone:702-324-4039
Mailing Address - Fax:909-625-8921
Practice Address - Street 1:2895 N TOWNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2009
Practice Address - Country:US
Practice Address - Phone:702-324-4039
Practice Address - Fax:909-625-8921
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV143432084N0400X
CAA1284412084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology