MEDICARE: JOANNE PATRICIA KEENAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20A 8728	CA

General Provider Information

NPI Number	:	1043281074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE PATRICIA KEENAN D.O.

Provider Business Mailing Address
First Line	:	6719 ALVARADO RD
Second Line	:	SUITE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5254
Country	:	US
Telephone Number	:	619-286-8804
Fax Number	:	619-286-2344

Provider Business Practice Location Address
First Line	:	6719 ALVARADO RD
Second Line	:	SUITE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5254
Country	:	US
Telephone Number	:	619-286-8804
Fax Number	:	619-286-2344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	03/05/2014

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