Provider Demographics
NPI:1750007951
Name:LATIFI, NAT (RAD-T)
Entity type:Individual
Prefix:
First Name:NAT
Middle Name:
Last Name:LATIFI
Suffix:
Gender:F
Credentials:RAD-T
Other - Prefix:
Other - First Name:NAT
Other - Middle Name:
Other - Last Name:LATIFI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RAD-T
Mailing Address - Street 1:1629 FRANKLIN ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4221
Mailing Address - Country:US
Mailing Address - Phone:805-990-6111
Mailing Address - Fax:
Practice Address - Street 1:1871 9TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4501
Practice Address - Country:US
Practice Address - Phone:310-314-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155060101Y00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor