Healthcare Provider Details

I. General information

NPI: 1760824403
Provider Name (Legal Business Name): EAMON KELEHER MD (STAFF PHYSICIAN)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax: 619-645-0193
Mailing address:
  • Phone: 619-532-6400
  • Fax: 619-645-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA147744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: