Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | C29865 | CA |
N | 207R00000X | Internist | C29865 | CA |
N | 111NI0900X | Internist | C29865 | CA |
Y | 207RA0201X | Internist - Allergy & Immunology | C29865 | CA |
NPI | 1306115001 |
---|---|
Provider Name | Jay A. Keystone |
First Address | Vacaville, CA 95688-2136 |
Second Address | Vacaville, CA 95688-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2011 |
Last Update Date | 09/04/2020 |