Jackson, Keelan Raphael

Jackson, Keelan Raphael is an individual health care provider with primary practice located at 34899 Bob Wilson Dr , San Diego CA 92134-0001. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Other Service Providers / Independent Duty Corpsman. Other Service Providers / Independent Duty Corpsman is his primary health care specialty. Jackson, Keelan Raphael can be contacted via phone (619) 532-6400.

Contact Information

Primary practice address
34899 Bob Wilson Dr San Diego CA 92134-0001
Phone: (619) 532-6400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Other Service Providers / Independent Duty Corpsman 1710I1002X California

Profile Details

NPI number 1790449882
LBN Legal business name Jackson, Keelan Raphael
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2021
Last updated Jun 15th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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