Healthcare Provider Details

I. General information

NPI: 1588412225
Provider Name (Legal Business Name): KEEYA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 E MARKER ST
LONG BEACH CA
90805-1219
US

IV. Provider business mailing address

269 E MARKER ST
LONG BEACH CA
90805-1219
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-6185
  • Fax:
Mailing address:
  • Phone: 310-991-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberY9150150
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberY9150150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: