Healthcare Provider Details

I. General information

NPI: 1609291517
Provider Name (Legal Business Name): GEORGE KEENAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 SUNSET AVE
FAIRFIELD CA
94533-4255
US

IV. Provider business mailing address

1695 SUNSET AVE
FAIRFIELD CA
94533-4255
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-8975
  • Fax:
Mailing address:
  • Phone: 707-648-8121
  • Fax: 707-648-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: