Active NPI
Keith Donavon Callow
- Addiction (Substance Use Disorder) Counselor
- Los Angeles, CA
National Provider Identifier
1326899261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 16891
- Practice address
- 12021 Wilmington Ave
Los Angeles, CA 90059-3019 - Phone
- (424) 454-6001
- Fax
- (310) 679-4621
- NPI assigned
- Mar 28, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16891 | CA | Primary |
Addresses
Primary practice location
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Mailing address
12021 Wilmington Ave
Los Angeles, CA 90059-3019
Phone (949) 426-9279
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16891 | CA | MD | Certified Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711584000000",
"number": "1326899261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900593019",
"telephone_number": "949-426-9279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900593019",
"telephone_number": "424-454-6001",
"fax_number": "310-679-4621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLOW",
"first_name": "KEITH",
"middle_name": "DONAVON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-28",
"last_updated": "2024-03-28",
"certification_date": "2024-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "16891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.