Provider Information for 1659789071
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KEITH MCGOWEN Jr.
Sex: Male
NPI: 1659789071
Last Updated: 2014-11-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1659789071 | ||||||||||||||||
| Enumeration Date | 2014-07-29 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 2275 ARLINGTON DR SAN LEANDRO, CA 94578-1132 United States Phone: 510-317-1444 | Fax: | ||||||||||||||||
| Primary Practice Address | 2275 ARLINGTON DR SAN LEANDRO, CA 94578-1132 United States Phone: 510-317-1444 | Fax: | ||||||||||||||||
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