Provider Demographics
NPI:1295502953
Name:KAMARA, DAUDA BLAQ
Entity type:Individual
Prefix:
First Name:DAUDA
Middle Name:BLAQ
Last Name:KAMARA
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 1:121 BROOKHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2555
Mailing Address - Country:US
Mailing Address - Phone:702-927-1134
Mailing Address - Fax:
Practice Address - Street 1:2727 W MCDOWELL ROAD APT266
Practice Address - Street 2:121 BROOKHOUSE CT
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011
Practice Address - Country:US
Practice Address - Phone:623-290-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNA103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities