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General NPI Number Information
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NPI Number | 1174901334
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Entity Type | Organization
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Legal Business Name | KEEN MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 12021 JACARANDA AVE SUITE # 101
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City | HESPERIA
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State | CA
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Zip | 92345-4978
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Country | US
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Telephone | 760-956-5057
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Fax | 760-948-2179
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Provider Business Mailing Address
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Address Line | 12021 JACARANDA AVE SUITE # 101
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City | HESPERIA
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State | CA
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Zip | 92345-4978
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Country | US
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Telephone | 760-956-5057
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Fax | 760-948-2179
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARLENE F BRAHAM
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Credential | M.D.
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Telephone | 760-956-5057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | G066379
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License Number State | CA
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