Provider Demographics
NPI:1003674821
Name:ALTAF, HUMA AHMED (DENTIST)
Entity type:Individual
Prefix:
First Name:HUMA
Middle Name:AHMED
Last Name:ALTAF
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2212
Mailing Address - Country:US
Mailing Address - Phone:559-802-4299
Mailing Address - Fax:
Practice Address - Street 1:828 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2212
Practice Address - Country:US
Practice Address - Phone:559-802-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist