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General NPI Number Information
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NPI Number | 1477069375
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Entity Type | Organization
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Legal Business Name | GAGE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 3203 E. FLORENCE AVE.
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-3008
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Country | US
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Telephone | 323-835-6310
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Fax | 323-835-6382
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Provider Business Mailing Address
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Address Line | 3203 E. FLORENCE AVENUE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-3908
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Country | US
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Telephone | 323-835-6310
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Fax | 323-835-6382
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | RICHARD C. KEECH
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Credential | M.D.
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Telephone | 562-699-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G29047
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License Number State | CA
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