Healthcare Provider Details

I. General information

NPI: 1891153680
Provider Name (Legal Business Name): KEYON ROBERTS MS, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 W MEDICI LN
INGLEWOOD CA
90305-1882
US

IV. Provider business mailing address

3623 W MEDICI LN
INGLEWOOD CA
90305-1882
US

V. Phone/Fax

Practice location:
  • Phone: 323-253-7729
  • Fax:
Mailing address:
  • Phone: 323-253-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA CERT#1-15-18781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: