Provider Demographics
NPI:1740447416
Name:KELTNER, JOHN ROBINSON
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBINSON
Last Name:KELTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:MC: 0603
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0603
Mailing Address - Country:US
Mailing Address - Phone:619-838-0519
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DR
Practice Address - Street 2:MC: 0603
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0603
Practice Address - Country:US
Practice Address - Phone:619-838-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA715142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry