Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1326211558 |
---|---|
Provider Name | Keavie Fisher |
First Address | El Centro, CA 92243-2328 |
Second Address | El Centro, CA 92243-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 09/04/2008 |