Individual
MS. KENYA'MICHELLE BEAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1210 LARRABEE ST APT 3, WEST HOLLYWOOD, CA 90069-6104
(702) 769-6442
Mailing address
920 WESTBOURNE DR APT 9, WEST HOLLYWOOD, CA 90069-4175
(702) 769-6442
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
615766
CA
Other
Enumeration date
06/05/2021
Last updated
06/05/2021
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