Active NPI
David Oliver Keenan, PA-C
- Physician Assistant
- Santa Cruz, CA
National Provider Identifier
1225167208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 12881
- Practice address
- 1555 Soquel Dr
Santa Cruz, CA 95065-1705 - Phone
- (831) 462-7710
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 12881 | CA | Primary |
Addresses
Primary practice location
1555 Soquel Dr
Santa Cruz, CA 95065-1705
Mailing address
180 Rancho Rio Ave
Ben Lomond, CA 95005-9478
Phone (831) 336-8614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 12881 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249948800000",
"number": "1225167208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 RANCHO RIO AVE",
"city": "BEN LOMOND",
"state": "CA",
"postal_code": "950059478",
"telephone_number": "831-336-8614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 SOQUEL DR",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950651705",
"telephone_number": "831-462-7710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEENAN",
"first_name": "DAVID",
"middle_name": "OLIVER",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2009-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA 12881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.