Provider Demographics
NPI:1174974646
Name:KEIME, AIRALIA SHANE (LM, LVN)
Entity type:Individual
Prefix:
First Name:AIRALIA
Middle Name:SHANE
Last Name:KEIME
Suffix:
Gender:F
Credentials:LM, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5236 LEWISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1265
Mailing Address - Country:US
Mailing Address - Phone:619-880-9433
Mailing Address - Fax:
Practice Address - Street 1:4455 TWAIN AVE
Practice Address - Street 2:SUITE H1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3458
Practice Address - Country:US
Practice Address - Phone:619-880-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 229858164X00000X
CALM469176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No164X00000XNursing Service ProvidersLicensed Vocational Nurse