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General NPI Number Information
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NPI Number | 1245690668
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Entity Type | Organization
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Legal Business Name | GENERAL AND PAIN PSYCHIATRY INC
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 04/24/2016
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Provider Practice Location Address
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Address Line | 36101 BOB HOPE DR SUITE B-2
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-2001
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Country | US
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Telephone | 619-838-0519
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 POWHATAN AVE
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City | SAN DIEGO
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State | CA
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Zip | 92117-2420
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Country | US
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Telephone | 619-838-0519
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. JOHN ROBINSON KELTNER
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Credential | MD
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Telephone | 619-838-0519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A71514
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | A71514
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License Number State | CA
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