MEDICARE: MS. KEISEAN BIANA RAINES CPS

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	172V00000X	Community Health Worker		CA
2	175T00000X	Peer Specialist		CA

General Provider Information

NPI Number	:	1265283188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEISEAN BIANA RAINES CPS

Provider Business Mailing Address
First Line	:	3515 ATLANTIC AVE # 1015
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4515
Country	:	US
Telephone Number	:	562-204-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 CEDAR WALK APT 2414
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7927
Country	:	US
Telephone Number	:	562-256-5149
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/04/2026

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