Provider Demographics
NPI:1528761483
Name:SALU, LATEEF
Entity type:Individual
Prefix:
First Name:LATEEF
Middle Name:
Last Name:SALU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17020 WILTHORNE GARDENS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2984
Mailing Address - Country:US
Mailing Address - Phone:713-474-7206
Mailing Address - Fax:
Practice Address - Street 1:17020 WILTHORNE GARDENS CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2984
Practice Address - Country:US
Practice Address - Phone:713-474-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNKK6788171W00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171W00000XOther Service ProvidersContractor