Individual
KEAVEN SA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
545 LAUREL ST, SAN DIEGO, CA 92101-1634
(619) 233-4399
(619) 233-0453
Mailing address
545 LAUREL ST, SAN DIEGO, CA 92101-1634
(619) 233-4399
(619) 233-0453
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-UKWGEO
CA
Other
Enumeration date
07/16/2026
Last updated
07/24/2026
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