Provider Demographics
NPI:1538418884
Name:ABDUL-LATIF, MARIAM LANTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:LANTIN
Last Name:ABDUL-LATIF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIAM
Other - Middle Name:LANTIN
Other - Last Name:ABDULLATIF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:BLDG 56, STE 600, ZOT 4490
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:714-456-6920
Mailing Address - Fax:714-456-7658
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:BLDG 56, STE 600, ZOT 4490
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6920
Practice Address - Fax:714-456-7658
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics