Healthcare Provider Details

I. General information

NPI: 1508271982
Provider Name (Legal Business Name): KEITH NOONAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415
US

IV. Provider business mailing address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415-0026
US

V. Phone/Fax

Practice location:
  • Phone: 909-347-1300
  • Fax: 909-347-1302
Mailing address:
  • Phone: 909-388-0810
  • Fax: 909-890-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2014020579
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A14757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: