Healthcare Provider Details

I. General information

NPI: 1699231621
Provider Name (Legal Business Name): LYNN KEITZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN SANTILLO RN

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 TEMPLE AVE STE B
SIGNAL HILL CA
90755-2212
US

IV. Provider business mailing address

21 CARMEL BAY DR
CORONA DEL MAR CA
92625-1006
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-7500
  • Fax: 562-424-9588
Mailing address:
  • Phone: 562-755-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: