Healthcare Provider Details

I. General information

NPI: 1962632331
Provider Name (Legal Business Name): KATHLEEN A KEAYS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25405 HANCOCK AVE STE 216
MURRIETA CA
92562-5978
US

IV. Provider business mailing address

25405 HANCOCK AVE STE 216
MURRIETA CA
92562-5978
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4600
  • Fax: 951-514-2542
Mailing address:
  • Phone: 951-698-4600
  • Fax: 951-514-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: