Provider Demographics
NPI:1245694736
Name:GATEAU, KAMEELAH
Entity type:Individual
Prefix:
First Name:KAMEELAH
Middle Name:
Last Name:GATEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAMEELAH
Other - Middle Name:
Other - Last Name:ABDULLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4650 W SUNSET BLVD # 68
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2122
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD # 68
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics