Provider Demographics
NPI:1033162771
Name:ENGLAND, KEITH R (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:ENGLAND
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Gender:M
Credentials:MD
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Mailing Address - Street 1:19951 MARINER AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1738
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:1225 WILSHIRE BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-977-2411
Practice Address - Fax:213-977-4079
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-12-08
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Provider Licenses
StateLicense IDTaxonomies
CAG54413207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G544130Medicaid
CA00G544130Medicaid
CAAN688ZMedicare PIN