Healthcare Provider Details

I. General information

NPI: 1457209827
Provider Name (Legal Business Name): CASSMIER KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N LAKE AVE STE 600
PASADENA CA
91101-5129
US

IV. Provider business mailing address

25745 BARTON RD # 257
LOMA LINDA CA
92354-3812
US

V. Phone/Fax

Practice location:
  • Phone: 626-354-6440
  • Fax:
Mailing address:
  • Phone: 951-237-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: