Basic Information
| Provider Information | |||||||||
| NPI: | 1235360009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEANE | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CFA, CST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12446 WEST AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782162517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106962663 | ||||||||
| FaxNumber: | 2105251669 | ||||||||
| Practice Location | |||||||||
| Address1: | 12446 WEST AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782162517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106962663 | ||||||||
| FaxNumber: | 2105251669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.