Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003255233 |
---|---|
Provider Name | Mr. Sean Allen Keyes SR. |
First Address | Los Angeles, CA 90046-3002 |
Second Address | Los Angeles, CA 90046-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 20/06/2013 |