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Individual

IBRAHIM KEITA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LVN/LPT

Contact information

Practice address
2148 SLATER ST, SANTA ROSA, CA 95404-2428
(707) 694-9005
Mailing address
2148 SLATER ST, SANTA ROSA, CA 95404-2428
(707) 694-9005

Taxonomy

Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT28951
CA

Other

Enumeration date
09/07/2016
Last updated
09/07/2016
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