Provider Demographics
NPI:1801823190
Name:MCGINNESS, LATIFFAH ABDULLAH (MD FAAP MBBS)
Entity Type:Individual
Prefix:MRS
First Name:LATIFFAH
Middle Name:ABDULLAH
Last Name:MCGINNESS
Suffix:
Gender:F
Credentials:MD FAAP MBBS
Other - Prefix:MRS
Other - First Name:LATIFFAH
Other - Middle Name:
Other - Last Name:ABDULLAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FAAP MBBS
Mailing Address - Street 1:67 CORTE MADERA
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532
Mailing Address - Country:US
Mailing Address - Phone:951-471-0042
Mailing Address - Fax:951-471-0422
Practice Address - Street 1:32299 WILDOMAR ROAD
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:951-471-0042
Practice Address - Fax:951-471-0422
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536380Medicaid
CA00A536380Medicaid