Healthcare Provider Details

I. General information

NPI: 1346733326
Provider Name (Legal Business Name): CHEYENNE KEZIAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BUTTERFIELD TRAIL BLVD UNIT 140
EL PASO TX
79906-4951
US

IV. Provider business mailing address

140 W FRANKLIN ST STE 202
MONTEREY CA
93940-2725
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6070
  • Fax:
Mailing address:
  • Phone: 800-991-6070
  • 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: