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CHARRO BIJAN KENNEBRUEW
NPI 1063053684
Licensed Psychiatric Technician in Lynwood, CA

Active since October 04, 2019
2640 INDUSTRY WAY, LYNWOOD, CA 90262(310) 627-4525 Get Directions Write a Review

NPPES record last updated: January 5, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 5, 2022, Jun 29, 2021, Sep 21, 2020 and 2 more (5 updates tracked since 2019).

About Charro Bijan Kennebruew NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARRO BIJAN KENNEBRUEW (NPI 1063053684) is an individual licensed psychiatric technician in Lynwood, California, licensed in California (37712) and active in the NPI registry since October 2019. She maintains 2 additional practice locations.

NPPES Registry Identity

NPI1063053684
Entity TypeIndividualFemale
Primary Taxonomy167G00000X
Provider Legal NameCHARRO BIJAN KENNEBRUEW
Location Address2640 INDUSTRY WAYLynwood, CA 90262-4284
Mailing Address2640 Industry WayLynwood, CA 90262-4284 · (310) 627-4525
Phone(310) 627-4525
Sole ProprietorNo
Enumeration DateOctober 4, 2019
Last NPPES UpdateJanuary 5, 20225 updates tracked since enumeration
NPPES CertifiedJanuary 5, 2022
✔ NPI 1063053684 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyLicensed Psychiatric TechnicianNursing Service Providers
Taxonomy Code167G00000X
License✔ Licensed in CA · 37712
Definition
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.
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X · License APCC7330 (CA)
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
2640 INDUSTRY WAY, Lynwood, CA 90262
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Secondary Practice Locations 2

Location 117695 Industrial Farm RdBakersfield, CA 93308-9520 · Phone (661) 391-3190
Location 23628 Stockdale HwyBakersfield, CA 93309-2153 · Phone (661) 322-1021

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRENT A. HART
Rehabilitation Practitioner
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (310) 639-5983
JANET DEL REAL
Social Worker
2640 INDUSTRY WAY, SUITE B
LYNWOOD, CA 90262
Los Angeles County (310) 627-4525
CHRISTIAN GONZALEZ
Marriage & Family Therapist
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (323) 203-5205
MR. DAVID TURNER
Rehabilitation Practitioner
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (310) 639-5983
NAKIA RENEE SIMON
Nurse Practitioner (Psychiatric/Mental Health)
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (310) 627-4525
TRACY FLORES PEEPLES LCSW
Social Worker (Clinical)
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (310) 631-8004
MS. JENNIFER P MIXON
Rehabilitation Practitioner
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (310) 639-5983
RACHEL LYNNETTE NICHOLS
Licensed Vocational Nurse
2640 INDUSTRY WAY
LYNWOOD, CA 90262
Los Angeles County (310) 627-4525

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charro Kennebruew's NPI number?

The NPI number for Charro Kennebruew is 1063053684. It was assigned to this individual provider in the NPPES registry on October 4, 2019.

Where is Charro Kennebruew located?

Charro Kennebruew practices at 2640 Industry Way, Lynwood, CA 90262. The listed phone number is (310) 627-4525.

What is Charro Kennebruew's specialty?

The primary specialty registered for this NPI is Licensed Psychiatric Technician with taxonomy code 167G00000X.

When was this NPI record last updated?

The NPPES record for Charro Kennebruew was last updated on January 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.