Provider Demographics
NPI:1386893766
Name:KEEKEEBHAI, AISHA (NP)
Entity type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:
Last Name:KEEKEEBHAI
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 1:3715 KELTON AVE
Mailing Address - Street 2:#3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7118
Mailing Address - Country:US
Mailing Address - Phone:310-837-5918
Mailing Address - Fax:
Practice Address - Street 1:12954 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4418
Practice Address - Country:US
Practice Address - Phone:310-978-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532567363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology