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General NPI Number Information
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NPI Number | 1104847250
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Entity Type | Organization
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Legal Business Name | PAUL R. KEITH MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11254 FLORINDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-1302
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Country | US
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Telephone | 619-977-1898
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Fax | 858-674-7493
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Provider Business Mailing Address
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Address Line | 11254 FLORINDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-1302
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Country | US
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Telephone | 619-977-1898
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Fax | 858-674-7493
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL RICHARD KEITH
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Credential | M.D.
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Telephone | 619-977-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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