Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A122318 | CA |
Y | 208600000X | Surgeon | A122318 | CA |
N | 2086S0102X | Surgical Critical Care | A122318 | CA |
NPI | 1194013797 |
---|---|
Provider Name | Dr. Jessica A Keeley |
First Address | Oakland, CA 94602-1018 |
Second Address | Oakland, CA 94602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2011 |
Last Update Date | 22/08/2018 |