Healthcare Provider Details

I. General information

NPI: 1235018003
Provider Name (Legal Business Name): KYRA NICOLE KERESZTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 OWENSMOUTH AVE
CANOGA PARK CA
91303-3198
US

IV. Provider business mailing address

20058 VENTURA BLVD # 277
WOODLAND HILLS CA
91364-2637
US

V. Phone/Fax

Practice location:
  • Phone: 818-347-8534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: