Provider Demographics
NPI:1285051227
Name:KEYS, CARA KRISTINE (RN)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:KRISTINE
Last Name:KEYS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:KRISTINE
Other - Last Name:MARTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1215 E CHAPMAN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2237
Mailing Address - Country:US
Mailing Address - Phone:714-516-9045
Mailing Address - Fax:714-516-9045
Practice Address - Street 1:1215 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2237
Practice Address - Country:US
Practice Address - Phone:714-516-9045
Practice Address - Fax:714-516-9860
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA791527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330150193OtherMEDI-CAL