Healthcare Provider Details

I. General information

NPI: 1518320266
Provider Name (Legal Business Name): KEELAN O'CONNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MITSCHER WAY BLDG #2258
SAN DIEGO CA
92145-0004
US

IV. Provider business mailing address

PSC 819 BOX 18 FPO AE 09645
ROTA CADIZ
11530
ES

V. Phone/Fax

Practice location:
  • Phone: 858-307-1011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number77842
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30394
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: