Provider Demographics
NPI:1427346402
Name:EDWARD KEATING
Entity type:Organization
Organization Name:EDWARD KEATING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:793501
Authorized Official - Phone:831-840-9051
Mailing Address - Street 1:16 SECONDO WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-5415
Mailing Address - Country:US
Mailing Address - Phone:831-840-9051
Mailing Address - Fax:
Practice Address - Street 1:21 SECONDO WAY
Practice Address - Street 2:
Practice Address - City:ROYAL OAKS
Practice Address - State:CA
Practice Address - Zip Code:95076-5414
Practice Address - Country:US
Practice Address - Phone:831-728-0421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA793501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty