Individual
MR. KEITH GLENN KENWORTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN,PHLEBOTOMIST
Contact information
Practice address
1764 N ORANGE DR, LOS ANGELES, CA 90028-4307
(323) 491-4765
Mailing address
1764 N ORANGE DR, LOS ANGELES, CA 90028-4307
(323) 491-4765
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
VN 267760
CA
246RP1900X
Phlebotomy Technician
Primary
CPT00040181
CA
Other
Enumeration date
01/16/2013
Last updated
01/16/2013
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