Healthcare Provider Details

I. General information

NPI: 1336391648
Provider Name (Legal Business Name): JAMES M KEENER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NAVAL MEDICAL CENTER SAN DIEGO
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

34800 BOB WILSON DR NAVAL MEDICAL CENTER SAN DIEGO
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-5600
  • Fax:
Mailing address:
  • Phone: 310-532-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: