Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CA |
NPI | 1154895944 |
---|---|
Provider Name | Keyonia K Paramore |
First Address | Long Beach, CA 90804-2880 |
Second Address | Long Beach, CA 90806-5240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2019 |
Last Update Date | 15/01/2019 |