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General NPI Number Information
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NPI Number | 1942156955
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Entity Type | Organization
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Legal Business Name | KETAMINE UPLIFT INC.
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 4640 ADMIRALTY WAY # 718A
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6621
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Country | US
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Telephone | 310-280-4440
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Fax | 310-929-8436
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Provider Business Mailing Address
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Address Line | 3111 VIA DOLCE APT 506
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5077
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Country | US
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Telephone | 310-965-6666
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Fax | 310-929-8436
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Authorized Official
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Title or Position | PRESIDENT/OWNER/MEDICAL DIRECTOR
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Name | DR. GEOFFERY ALAN O'NEILL
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Credential | MD
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Telephone | 310-965-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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