MEDICARE: AIRALIA SHANE KEIME LM, LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN 229858	CA
2	176B00000X	Midwife	LM469	CA

General Provider Information

NPI Number	:	1174974646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIRALIA SHANE KEIME LM, LVN

Provider Business Mailing Address
First Line	:	5236 LEWISON AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1265
Country	:	US
Telephone Number	:	619-880-9433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 TWAIN AVE
Second Line	:	SUITE H1
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-3458
Country	:	US
Telephone Number	:	619-880-9433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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