Provider Demographics
NPI:1659685568
Name:RAFIK LATIF MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAFIK LATIF MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-885-0061
Mailing Address - Street 1:18250 ROSCOE BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4281
Mailing Address - Country:US
Mailing Address - Phone:818-885-0061
Mailing Address - Fax:818-885-0083
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4281
Practice Address - Country:US
Practice Address - Phone:818-885-0061
Practice Address - Fax:818-885-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA337264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337264Medicaid
A33726OtherMEDICARE ID NUMBER
CA00A337264Medicaid