MEDICARE: WAHID LATIF D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20A10499	CA

General Provider Information

NPI Number	:	1285898056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAHID LATIF D.O.

Provider Business Mailing Address
First Line	:	2123 RODNEY DR APT 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 W SUNSET BLVD FL 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5822
Country	:	US
Telephone Number	:	805-407-5018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	12/03/2021

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