Provider Demographics
NPI:1114548872
Name:ALTAMIMI, ELLAF SABAH
Entity type:Individual
Prefix:
First Name:ELLAF
Middle Name:SABAH
Last Name:ALTAMIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 LOMA PEDREGOSA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1582
Mailing Address - Country:US
Mailing Address - Phone:505-484-7451
Mailing Address - Fax:
Practice Address - Street 1:3115 LOMA PEDREGOSA NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1582
Practice Address - Country:US
Practice Address - Phone:505-484-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker