Healthcare Provider Details

I. General information

NPI: 1528903382
Provider Name (Legal Business Name): KEIYANA JANAE BLACKWELL LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 AVALON BLVD
LOS ANGELES CA
90061-2866
US

IV. Provider business mailing address

547 E 169TH ST
CARSON CA
90746-1104
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-0500
  • Fax: 323-242-0600
Mailing address:
  • Phone: 323-252-0500
  • Fax: 323-242-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number759402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: