Provider Demographics
NPI:1578936035
Name:KEYS, JENIQUE
Entity Type:Individual
Prefix:
First Name:JENIQUE
Middle Name:
Last Name:KEYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3212
Mailing Address - Country:US
Mailing Address - Phone:619-299-0840
Mailing Address - Fax:
Practice Address - Street 1:3630 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3212
Practice Address - Country:US
Practice Address - Phone:619-299-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705970163WX0003X
CACNM2802176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient