Healthcare Provider Details

I. General information

NPI: 1093251779
Provider Name (Legal Business Name): KEHAU KALANI KUALA GILBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23119 COTTONWOOD AVE STE 100
MORENO VALLEY CA
92553
US

IV. Provider business mailing address

23119 COTTONWOOD AVE STE 100
MORENO VALLEY CA
92553-9661
US

V. Phone/Fax

Practice location:
  • Phone: 951-413-3509
  • Fax:
Mailing address:
  • Phone: 951-413-3509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 73355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: