Healthcare Provider Details

I. General information

NPI: 1235554403
Provider Name (Legal Business Name): KARLIN LADERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 MAPLE AVE APT 3
SOLVANG CA
93463-2645
US

IV. Provider business mailing address

1669 MAPLE AVE APT 3
SOLVANG CA
93463-2645
US

V. Phone/Fax

Practice location:
  • Phone: 805-350-0429
  • Fax: 805-865-1954
Mailing address:
  • Phone: 805-350-0429
  • Fax: 805-865-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: