Basic Information
| Provider Information | |||||||||
| NPI: | 1629022553 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LATIF | ||||||||
| FirstName: | SHAHID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 ELM AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624926695 | ||||||||
| FaxNumber: | 5629880389 | ||||||||
| Practice Location | |||||||||
| Address1: | 18280 SISKIYOU RD | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923071413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602429999 | ||||||||
| FaxNumber: | 7602421121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 30940 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | C129435 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | AZ0727110 | 01 | AZ | BCBS | OTHER | 745763 | 05 | AZ | MEDICAID | 777903 | 01 | AZ | WELLCARE MEDICARE ADVANTAGE | OTHER |