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General NPI Number Information
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NPI Number | 1235542127
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Entity Type | Individual
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Provider Name | GABRIEL EDUARDO KEOGAN
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Gender | Male
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 4367 CONCORD BLVD
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City | CONCORD
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State | CA
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Zip | 94521-1145
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Country | US
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Telephone | 925-689-7457
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 PALLADIUM DR
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City | GREENSBORO
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State | NC
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Zip | 27410-9102
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Country | US
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Telephone | 925-914-9692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 11868
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License Number State | NC
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