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Individual

NELAE JONTUE KEENE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
2787 BRISTOL ST STE 210, COSTA MESA, CA 92626-5956
(949) 515-7300
Mailing address
2787 BRISTOL ST STE 210, COSTA MESA, CA 92626-5956
(949) 515-7300

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
21875
CA

Other

Enumeration date
10/28/2011
Last updated
12/12/2018
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