Healthcare Provider Details

I. General information

NPI: 1679839005
Provider Name (Legal Business Name): KATHLEEN L KEATING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KATHLEEN L CUNNINGHAM

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 CENTRAL AVE STE 100
RIVERSIDE CA
92506-2708
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 951-359-0660
  • Fax:
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A12905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: