Provider Demographics
NPI:1457184020
Name:KADARA, LATEEF O
Entity type:Individual
Prefix:MR
First Name:LATEEF
Middle Name:O
Last Name:KADARA
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 1:20353 SATICOY ST APT 12
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2572
Mailing Address - Country:US
Mailing Address - Phone:925-640-8921
Mailing Address - Fax:
Practice Address - Street 1:20353 SATICOY ST APT 12
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2572
Practice Address - Country:US
Practice Address - Phone:925-640-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker