Provider Demographics
NPI:1780656843
Name:LATIFF, GUILLERMO A (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:A
Last Name:LATIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7420 REMCON CIR
Mailing Address - Street 2:BLDG A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3508
Mailing Address - Country:US
Mailing Address - Phone:915-532-8823
Mailing Address - Fax:915-532-5909
Practice Address - Street 1:7420 REMCON CIR
Practice Address - Street 2:BLDG A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3508
Practice Address - Country:US
Practice Address - Phone:915-532-8823
Practice Address - Fax:915-225-2015
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK6080208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118015001Medicaid
TXF64540Medicare UPIN