Healthcare Provider Details

I. General information

NPI: 1265283188
Provider Name (Legal Business Name): KEISEAN BIANA RAINES CPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CEDAR WALK APT 2414
LONG BEACH CA
90802-7927
US

IV. Provider business mailing address

3515 ATLANTIC AVE # 1015
LONG BEACH CA
90807-4515
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-5149
  • Fax:
Mailing address:
  • Phone: 562-204-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: