| Organization Name: | KEEN MEDICAL GROUP INC |
| NPI Number: | 1174901334 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ARLENE F BRAHAM (PRESIDENT) |
| Mailing Address: | 12021 Jacaranda Ave Suite # 101 Hesperia |
| State: | CA US |
| Postal Code: | 923454978 |
| Phone Number: | 7609565057 |
| Fax Number: | 7609482179 |
| NPI Enumeration Date: | 05/08/2015 |
| NPI Last Update Date: | 05/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LX0106X |
| License Number: | G066379 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Occupational Health |
| Taxonomy Definition: | |