Healthcare Provider Details

I. General information

NPI: 1265663611
Provider Name (Legal Business Name): KEILA JENAE TRIMBLE-COX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15446 S WESTERN AVE
GARDENA CA
90249-4319
US

IV. Provider business mailing address

15446 S WESTERN AVE
GARDENA CA
90249-4319
US

V. Phone/Fax

Practice location:
  • Phone: 310-965-4826
  • Fax:
Mailing address:
  • Phone: 310-965-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: