Healthcare Provider Details

I. General information

NPI: 1174800288
Provider Name (Legal Business Name): KEITH JOHN PFLIEGER CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538
US

IV. Provider business mailing address

2335 HERITAGE CT
SAN JOSE CA
95124-1213
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-3474
  • Fax:
Mailing address:
  • Phone: 408-373-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: