Basic Information
Provider Information
NPI: 1518432319
EntityType: 2
ReplacementNPI:  
OrganizationName: ANNETTE A KEOCHEKIAN MD INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7096
Address2:  
City: STOCKTON
State: CA
PostalCode: 952670096
CountryCode: US
TelephoneNumber: 2099567725
FaxNumber: 2099567733
Practice Location
Address1: 2288 AUBURN BLVD STE 201
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958211620
CountryCode: US
TelephoneNumber: 9169297229
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/08/2018
LastUpdateDate: 09/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KEOCHEKIAN
AuthorizedOfficialFirstName: ANNETTE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9169297229
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home