Provider Demographics
NPI:1265289870
Name:ISMAIL, SAUDAH KM (RADT)
Entity type:Individual
Prefix:
First Name:SAUDAH
Middle Name:KM
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:MRS
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:KAKOOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBA-HEALTHCARE, SC
Mailing Address - Street 1:6022 VARIEL AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3719
Mailing Address - Country:US
Mailing Address - Phone:818-996-1051
Mailing Address - Fax:
Practice Address - Street 1:6022 VARIEL AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3719
Practice Address - Country:US
Practice Address - Phone:818-996-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR14186401234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)