Provider Demographics
NPI:1932369840
Name:FANDAL, KESZEMA Z
Entity Type:Individual
Prefix:MISS
First Name:KESZEMA
Middle Name:Z
Last Name:FANDAL
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 1:1152 GORDON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1913
Mailing Address - Country:US
Mailing Address - Phone:323-356-0615
Mailing Address - Fax:
Practice Address - Street 1:3701 WILSHIRE BLVD
Practice Address - Street 2:STE 900
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2804
Practice Address - Country:US
Practice Address - Phone:213-637-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator