Provider Demographics
NPI:1780896951
Name:KEENE, CAMILLE YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:YVONNE
Last Name:KEENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5510
Mailing Address - Country:US
Mailing Address - Phone:707-263-4441
Mailing Address - Fax:707-263-4449
Practice Address - Street 1:825 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5510
Practice Address - Country:US
Practice Address - Phone:707-263-4441
Practice Address - Fax:707-263-4449
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG873882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G873880OtherMEDI-CAL
CAF60634Medicare UPIN
CAZZZ01567ZMedicare ID - Type Unspecified