Provider Demographics
NPI:1730323866
Name:GASSOWAY STEVENSON, CHINA KEYONNIE
Entity Type:Individual
Prefix:MS
First Name:CHINA
Middle Name:KEYONNIE
Last Name:GASSOWAY STEVENSON
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 1:3605 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 331
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4013
Mailing Address - Country:US
Mailing Address - Phone:562-989-0515
Mailing Address - Fax:562-421-7221
Practice Address - Street 1:4010 WATSON PLAZA DR
Practice Address - Street 2:SUITE 135
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4037
Practice Address - Country:US
Practice Address - Phone:562-421-7225
Practice Address - Fax:562-421-7221
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator