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General NPI Number Information
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NPI Number | 1639724776
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Entity Type | Individual
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Provider Name | KEISHA OMWANGHE M.C.D.,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 14369 PARK AVE STE 201A
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City | VICTORVILLE
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State | CA
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Zip | 92392-2300
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Country | US
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Telephone | 760-278-1484
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Fax | 855-719-8152
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Provider Business Mailing Address
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Address Line | 14369 PARK AVE STE 201A
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City | VICTORVILLE
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State | CA
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Zip | 92392-2300
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Country | US
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Telephone | 760-278-1484
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Fax | 855-719-2558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 38218
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License Number State | CA
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