Healthcare Provider Details

I. General information

NPI: 1801823190
Provider Name (Legal Business Name): LATIFFAH ABDULLAH MCGINNESS MD FAAP MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATIFFAH ABDULLAH MD FAAP MBBS

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32299 WILDOMAR ROAD
LAKE ELSINORE CA
92530
US

IV. Provider business mailing address

67 CORTE MADERA
LAKE ELSINORE CA
92532
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-0042
  • Fax: 951-471-0422
Mailing address:
  • Phone: 951-471-0042
  • Fax: 951-471-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: