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NPI Code Detail

MEDICARE: DR. KEISHA N MASCAL PSYD

MEDICARE: DR. KEISHA N MASCAL PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist36597CA
2225400000XRehabilitation Practitioner
3390200000XStudent in an Organized Health Care Education/Training Program
4106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1982738449
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEISHA N MASCAL PSYD
Provider Business Mailing Address
First Line : 43824 20TH ST W # 2523
Second Line :
City : LANCASTER
State : CA
Zip : 93534-5201
Country : US
Telephone Number : 323-377-1882
Fax Number :
Provider Business Practice Location Address
First Line : 1721 GRIFFIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-3312
Country : US
Telephone Number : 323-221-4134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 03/02/2026

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