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General NPI Number Information
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NPI Number | 1821288101
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Entity Type | Organization
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Legal Business Name | LAKEPORT NEUROLOGY INC
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 5124 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-263-4441
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Fax | 707-263-4449
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Provider Business Mailing Address
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Address Line | 5124 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-263-4441
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. CAMILLE YVONNE KEENE
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Credential | MD
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Telephone | 707-263-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | G87388
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License Number State | CA
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