Healthcare Provider Details

I. General information

NPI: 1629746250
Provider Name (Legal Business Name): SUSAN KEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD # 1
LOS ANGELES CA
90027-6082
US

IV. Provider business mailing address

3923 ELROVIA AVE
EL MONTE CA
91731-2135
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-1369
  • Fax:
Mailing address:
  • Phone: 626-328-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: