Provider Demographics
NPI:1487249371
Name:MCKELLAR, ALIYAH (LVN)
Entity type:Individual
Prefix:
First Name:ALIYAH
Middle Name:
Last Name:MCKELLAR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 GOLF MEADOWS CT # CA
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2472
Mailing Address - Country:US
Mailing Address - Phone:885-922-7323
Mailing Address - Fax:
Practice Address - Street 1:2734 GOLF MEADOWS CT # CA
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2472
Practice Address - Country:US
Practice Address - Phone:855-922-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN707376163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN707376Medicaid