Provider Demographics
NPI:1346529823
Name:HOBBS, KEYNAN (NP)
Entity Type:Individual
Prefix:
First Name:KEYNAN
Middle Name:
Last Name:HOBBS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 GROSSMONT BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4047
Mailing Address - Country:US
Mailing Address - Phone:858-380-7691
Mailing Address - Fax:
Practice Address - Street 1:8900 GROSSMONT BLVD
Practice Address - Street 2:STE 4
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4047
Practice Address - Country:US
Practice Address - Phone:858-380-7691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health