Healthcare Provider Details

I. General information

NPI: 1417893801
Provider Name (Legal Business Name): JILLIAN O'KEEFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 CAMINO DEL RIO N STE 105
SAN DIEGO CA
92108-1747
US

IV. Provider business mailing address

3570 CAMINO DEL RIO N STE 105
SAN DIEGO CA
92108-1747
US

V. Phone/Fax

Practice location:
  • Phone: 619-874-0600
  • Fax:
Mailing address:
  • Phone: 619-874-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: