Provider Demographics
NPI:1831368125
Name:KEANA TURNER
Entity type:Organization
Organization Name:KEANA TURNER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-632-8823
Mailing Address - Street 1:10312 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7718
Mailing Address - Country:US
Mailing Address - Phone:323-632-8823
Mailing Address - Fax:760-246-7878
Practice Address - Street 1:11497 BARTLETT AVE STE B3
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-1901
Practice Address - Country:US
Practice Address - Phone:760-246-7575
Practice Address - Fax:760-246-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015631332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6195200001Medicare NSC