Individual
KEILONI MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 E ALOSTA AVE, AZUSA, CA 91702-2701
(626) 969-3434
Mailing address
273 W ARROW HWY APT 80, AZUSA, CA 91702-5469
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
Y4201286
CA
390200000X
Student in an Organized Health Care Education/Training Program
Y4201286
CA
Other
Enumeration date
06/02/2020
Last updated
06/02/2020
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