Provider Demographics
NPI:1265283188
Name:RAINES, KEISEAN BIANA (CPS)
Entity type:Individual
Prefix:MS
First Name:KEISEAN
Middle Name:BIANA
Last Name:RAINES
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 ATLANTIC AVE # 1015
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4515
Mailing Address - Country:US
Mailing Address - Phone:562-204-6680
Mailing Address - Fax:
Practice Address - Street 1:40 CEDAR WALK APT 2414
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-7927
Practice Address - Country:US
Practice Address - Phone:562-256-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist