Healthcare Provider Details

I. General information

NPI: 1669366415
Provider Name (Legal Business Name): KHERMAEL ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

100 N PACIFIC COAST HWY STE 1400
EL SEGUNDO CA
90245-5602
US

V. Phone/Fax

Practice location:
  • Phone: 443-430-7570
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: