Provider Demographics
NPI:1578939377
Name:PRICE, KEIALA (NP)
Entity Type:Individual
Prefix:MS
First Name:KEIALA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 W HILLSDALE ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1124
Mailing Address - Country:US
Mailing Address - Phone:707-389-0225
Mailing Address - Fax:
Practice Address - Street 1:2121 YGNACIO VALLEY RD
Practice Address - Street 2:BUILDING E SUITE 101
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3383
Practice Address - Country:US
Practice Address - Phone:925-945-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-15
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily