Healthcare Provider Details

I. General information

NPI: 1063545648
Provider Name (Legal Business Name): KEITH SPENCER LOUW IMF 44227
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E GRAND AVE
ESCONDIDO CA
92027-3019
US

IV. Provider business mailing address

398 D ST
RAMONA CA
92065-2463
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-4126
  • Fax: 760-489-4129
Mailing address:
  • Phone: 760-788-9724
  • Fax: 760-788-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 44227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: