Provider Demographics
NPI:1225900434
Name:MORALES BRONFIELD, KEYSLY BIVELOTH
Entity type:Individual
Prefix:
First Name:KEYSLY
Middle Name:BIVELOTH
Last Name:MORALES BRONFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1643
Mailing Address - Country:US
Mailing Address - Phone:213-952-0050
Mailing Address - Fax:
Practice Address - Street 1:8928 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3228
Practice Address - Country:US
Practice Address - Phone:323-750-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical