Provider Demographics
NPI:1932462488
Name:KAZIM, LATEEF ALADE (LVN)
Entity Type:Individual
Prefix:
First Name:LATEEF
Middle Name:ALADE
Last Name:KAZIM
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12129 MANOR DR APT 36
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-0215
Mailing Address - Country:US
Mailing Address - Phone:323-899-5222
Mailing Address - Fax:
Practice Address - Street 1:12129 MANOR DRIVE APT 36
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:323-899-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 238317164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse