Provider Demographics
NPI:1760847669
Name:KEILBERG, DIANE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:KEILBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 W 237TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6104
Mailing Address - Country:US
Mailing Address - Phone:310-961-0772
Mailing Address - Fax:
Practice Address - Street 1:721 S GLASGOW AVE
Practice Address - Street 2:STE C
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3014
Practice Address - Country:US
Practice Address - Phone:310-665-1121
Practice Address - Fax:310-665-1141
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 468881835P0018X
TX296911835P0018X
AZS0201481835P0018X
NV186831835P0018X
ORRPH-00151091835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist