Provider Demographics
NPI:1134667751
Name:ABDULLATIF, QUTAYBA (PHD)
Entity Type:Individual
Prefix:DR
First Name:QUTAYBA
Middle Name:
Last Name:ABDULLATIF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E FOOTHILL BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7122
Mailing Address - Country:US
Mailing Address - Phone:626-460-1260
Mailing Address - Fax:626-628-3051
Practice Address - Street 1:2500 E FOOTHILL BLVD STE 406
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7122
Practice Address - Country:US
Practice Address - Phone:626-460-1260
Practice Address - Fax:626-628-3051
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28804103TC0700X, 103TC0700X, 103TC1900X, 103TH0004X, 103TC1900X, 103TF0000X, 103TH0004X, 103TH0100X, 103TP2701X, 103TH0100X, 103TP2701X, 405300000X
CAPSY28804103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB281537OtherMEDICARE
CA5672641Medicaid