Provider Demographics
NPI:1134678964
Name:KEATING, ANDREW (LAC, MSTOM, DAOM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:KEATING
Suffix:
Gender:M
Credentials:LAC, MSTOM, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 SEACOAST DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-3172
Mailing Address - Country:US
Mailing Address - Phone:858-449-4659
Mailing Address - Fax:
Practice Address - Street 1:3636 FIFTH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4281
Practice Address - Country:US
Practice Address - Phone:858-449-4659
Practice Address - Fax:619-794-0260
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist