Healthcare Provider Details

I. General information

NPI: 1578093597
Provider Name (Legal Business Name): LENAH KEBASO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NEWBURN CT
BEAUMONT CA
92223-3130
US

IV. Provider business mailing address

306 STELLER DR
BEAR DE
19701-4920
US

V. Phone/Fax

Practice location:
  • Phone: 909-556-1300
  • Fax:
Mailing address:
  • Phone: 951-524-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95050338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: