Healthcare Provider Details

I. General information

NPI: 1578019071
Provider Name (Legal Business Name): MISS CASSANDRA SHELBY KEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44460 20TH ST W SIDE B
LANCASTER CA
93534-2714
US

IV. Provider business mailing address

44460 20TH ST W SIDE B
LANCASTER CA
93534-2714
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1111
  • Fax:
Mailing address:
  • Phone: 714-834-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: