IBRAHIM KEITA (NPI# 1184171134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184171134 |
| Entity Type | Individual |
| Full Name | IBRAHIM KEITA |
| Credential | LVN/LPT |
| Practice Address |
2148 Slater St Santa Rosa CA 95404-2428 |
| Practice Telephone | 7076949005 |
| Mailing Telephone | 7076949005 |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 167G00000X | Licensed Psychiatric Technician | PT28951 | CA | Nursing Service Providers |
| Street Address |
2148 SLATER ST |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95404-2428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1114492162 | Jesse Earl Rathbun Jr. | Ophthalmology | 1920 Grace Dr., Santa Rosa, CA 95404 | 2018-10-05 |
| 1568958437 | Bianca Avina | Marriage & Family Therapist | 95 Montgomery Dr. #112, Santa Rosa, CA 95404 | 2018-07-03 |
| 1366940504 | New Leaf Counseling and Psychotherapy | Marriage & Family Therapist | 1030 2n Street, Suite B, Santa Rosa, CA 95404 | 2018-01-23 |
| 1659884864 | Jessica Vargas Lopez | Counselor | 3333 Chanate Road, Santa Rosa, CA 95404 | 2017-11-09 |
| 1982135992 | Gaea Keridwyn Coon | Marriage & Family Therapist | 884 Third Street, Suite D, Santa Rosa, CA 95404 | 2017-03-22 |
| 1376084699 | Empire Traditional Chinese Medicine | Acupuncturist | 1030 Second St, Santa Rosa, CA 95404 | 2017-03-20 |
| 1356888705 | Webster Surgery Center, Lp | Clinic/Center | 730 Bennett Valley Road, Santa Rosa, CA 95404 | 2017-01-24 |
| 1205295979 | Sandra Lee Krikorian | Social Worker | 101 E Street, Suite 312, Santa Rosa, CA 95404 | 2016-02-23 |
| 1396134615 | The Center for Body Oriented Psychotherapy & Wellness | Psychologist | 1626 Fourth Street, Santa Rosa, CA 95404 | 2015-01-12 |
| Find all providers in zip 95404 | ||||
| Taxonomy Code | 167G00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Psychiatric Technician |
| An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306246889 | Yazmin Ruiz | Licensed Psychiatric Technician | 1901 Cleveland Avenue, Suite B, Santa Rosa Treatment Program, Santa Rosa, CA 95403 | 2014-09-03 |
| 1558975169 | Nebiyou Almaw Amshalu | Licensed Psychiatric Technician | 327 College Ave, Santa Rosa, CA 95401-5117 | 2020-09-01 |
| 1457999286 | Irma Martinez | Licensed Psychiatric Technician | 327 College Ave, Santa Rosa, CA 95401-5117 | 2019-12-11 |
| 1003459181 | Megan Gordon | Licensed Psychiatric Technician | 327 College Ave, Santa Rosa, CA 95401-5117 | 2019-10-22 |
| 1063977460 | Gardner Carlson | Licensed Psychiatric Technician | 2225 Challenger Way, Santa Rosa, CA 95407-5441 | 2019-02-10 |
| 1285185819 | Bruce Black | Licensed Psychiatric Technician | 2225 Challenger Way, Santa Rosa, CA 95407 | 2016-10-19 |
| 1477926194 | Andrea Yvonne Quintana I | Licensed Psychiatric Technician | 1901 Cleveland Ave Ste B, Santa Rosa, CA 95401-4298 | 2015-11-03 |
| 1851644371 | Amanda Johanna Menary | Licensed Psychiatric Technician | 1901 Cleveland Ave, Santa Rosa, CA 95401-4282 | 2012-10-22 |
| 1194029371 | Denise Black | Licensed Psychiatric Technician | 327 College Ave, Santa Rosa, CA 95401-5117 | 2011-01-03 |
| 1679892939 | Linda Marie Bertolini | Licensed Psychiatric Technician | 1901 Cleveland Ave Ste B, Santa Rosa, CA 95401-4298 | 2010-05-26 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.