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General NPI Number Information
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NPI Number | 1932427531
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Entity Type | Individual
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Provider Name | BRENT KEIME LAC
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Gender | Male
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/07/2010
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Provider Practice Location Address
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Address Line | 4410 LAMONT ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-4515
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Country | US
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Telephone | 858-483-8500
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Fax | 858-272-0054
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Provider Business Mailing Address
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Address Line | 5236 LEWISON AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-1265
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Country | US
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Telephone | 619-977-8851
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Fax | 858-272-0054
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 11462
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License Number State | CA
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