Healthcare Provider Details

I. General information

NPI: 1811915812
Provider Name (Legal Business Name): JASON SHAMMUEL KERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 CAMINO DEL RIO S STE 102
SAN DIEGO CA
92108-3818
US

IV. Provider business mailing address

2810 CAMINO DEL RIO S STE 102
SAN DIEGO CA
92108-3818
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-4374
  • Fax: 866-611-4220
Mailing address:
  • Phone: 619-299-4374
  • Fax: 866-611-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA82017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: