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General NPI Number Information
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NPI Number | 1003359555
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Entity Type | Organization
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Legal Business Name | KEITH EBILANE, M.D., INC.
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 13429 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-5803
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Country | US
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Telephone | 310-644-8683
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Fax | 310-644-0132
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Provider Business Mailing Address
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Address Line | 13429 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-5803
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KEITH EBILANE
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Credential | M.D.
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Telephone | 310-644-8683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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