Healthcare Provider Details

I. General information

NPI: 1760126676
Provider Name (Legal Business Name): SAMANTHA ERIKA KEEFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ERIKA GRUTZNER

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 RENDOVA RD
SAN DIEGO CA
92155-5490
US

IV. Provider business mailing address

2841 RENDOVA RD
SAN DIEGO CA
92155-5490
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-2860
  • Fax:
Mailing address:
  • Phone: 619-437-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279743
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101279743
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: