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General NPI Number Information
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NPI Number | 1225992068
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Entity Type | Organization
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Legal Business Name | KWS NEURO GROUP
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 4645 CASS ST STE 204
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City | SAN DIEGO
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State | CA
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Zip | 92109-2848
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Country | US
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Telephone | 619-820-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 8584 CLIFFRIDGE AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-2110
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Country | US
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Telephone | 619-820-9442
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEITH ALAN BLANKENSHIP
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Credential |
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Telephone | 619-820-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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