Healthcare Provider Details

I. General information

NPI: 1922562685
Provider Name (Legal Business Name): MS. KELIANA DE NEEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 UNIVERSITY BLVD SE
ALBUQUERQUE NM
87106-4320
US

IV. Provider business mailing address

9946 SCRIBNER AVE
WHITTIER CA
90605-3222
US

V. Phone/Fax

Practice location:
  • Phone: 562-298-8011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: