Healthcare Provider Details

I. General information

NPI: 1033162771
Provider Name (Legal Business Name): KEITH R. ENGLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WILSHIRE BLVD.
LOS ANGELES CA
90017
US

IV. Provider business mailing address

19951 MARINER AVE STE 155
TORRANCE CA
90503-1738
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-2411
  • Fax: 213-977-4079
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG54413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: