Provider Demographics
NPI:1932427531
Name:KEIME, BRENT (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:KEIME
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5236 LEWISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1265
Mailing Address - Country:US
Mailing Address - Phone:619-977-8851
Mailing Address - Fax:858-272-0054
Practice Address - Street 1:4410 LAMONT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4515
Practice Address - Country:US
Practice Address - Phone:858-483-8500
Practice Address - Fax:858-272-0054
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist