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General NPI Number Information
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NPI Number | 1073997359
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA GASTROENTEROLOGY ANESTHESIA SPECIA
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 286 EUCLID AVE SUITE #109
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City | SAN DIEGO
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State | CA
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Zip | 92114-3610
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Country | US
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Telephone | 619-266-1653
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Fax |
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Provider Business Mailing Address
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Address Line | 286 EUCLID AVE STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92114-3611
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN G KEENAN
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Credential | CRNA
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Telephone | 619-857-8764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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