NELAE JONTUE KEENE (NPI# 1790061208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790061208 |
| Entity Type | Individual |
| Full Name | NELAE JONTUE KEENE |
| Credential | PA-C |
| Practice Address |
2787 Bristol St Ste 210 Costa Mesa CA 92626-5956 |
| Practice Telephone | 9495157300 |
| Mailing Telephone | 9495157300 |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2018-12-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
21875 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Park Plz, Suite 600, Irvine, CA 926145910 | 9498527377 |
| Street Address |
2787 BRISTOL ST STE 210 |
| City | COSTA MESA |
| State | CA |
| Zip Code | 92626-5956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536982 | Sergio Gutierrez | Behavior Technician | 3303 Harbor Blvd., Suite B8, Costa Mesa, CA 92626 | 2020-10-22 |
| 1780201848 | Kelly Chauvet | Behavior Technician | 1503 Nutmeg Place Suite 110, Costa Mesa, CA 92626 | 2020-07-06 |
| 1316564610 | Timo Rosa | Behavior Technician | 1503 Nutmeg Place, Suite 110, Costa Mesa, CA 92626 | 2020-07-02 |
| 1255966115 | Dalia A Sehweil | Behavior Technician | 1111 Baker, Costa Mesa, CA 92626 | 2020-03-11 |
| 1265071096 | Austin Stotelmyre | Behavior Technician | 1111 Baker St Costa Mesa 92626, Costa Mesa, CA 92626 | 2019-12-26 |
| 1396383022 | The Open Table | Community/Behavioral Health | 151 Kalmus Dr. Bldg C, Suite 100, Costa Mesa, CA 92626 | 2019-12-12 |
| 1851933550 | Jennifer Rivera | Behavior Technician | 1111 Baker St. Unit #a, Costa Mesa, CA 92626 | 2019-10-14 |
| 1962053595 | Peter Na | Behavior Technician | Behavior Functions 3303 Harbor Blvd, Ste B8, Costa Mesa, CA 92626 | 2019-09-25 |
| 1346897147 | Jennifer Lopez | Behavior Technician | 555 Alton Blvd Suite 150, Costa Mesa, CA 92626 | 2019-08-26 |
| 1679134084 | Danny Garcia Chiropractic, PC | Chiropractor | 1503 South Coast Drive, Suite 319, Costa Mesa, CA 92626 | 2019-06-26 |
| Find all providers in zip 92626 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871501254 | Ronald L Ellison | Physician Assistant | 352 Costa Mesa St, Costa Mesa, CA 92627-2355 | 2006-08-03 |
| 1063894988 | Christina Thi Nguyen | Physician Assistant | 1550 Superior Ave, Costa Mesa, CA 92627-3653 | 2015-06-27 |
| 1942627880 | Jennifer Sebastian | Physician Assistant | 3151 Airway Ave Ste G1, Costa Mesa, CA 92626-4624 | 2014-03-27 |
| 1528481199 | Andrea Paige Shandling | Physician Assistant | 3151 Airway Ave, Bldg T, Ste 3, Costa Mesa, CA 92626-4607 | 2014-02-01 |
| 1710329503 | Sara Coburn | Physician Assistant | 1550 Superior Ave, Costa Mesa, CA 92627-3653 | 2013-07-23 |
| 1043575723 | Benjamin Charles Kaska | Physician Assistant | 1550 Superior Ave, Costa Mesa, CA 92627-3653 | 2012-07-10 |
| 1477837862 | Tamara O'nan | Physician Assistant | 1190 W. Baker St, Ste 100, Costa Mesa, CA 92626-4105 | 2011-10-04 |
| 1427285949 | Roxana Reynafarje | Physician Assistant | 745 W 19th St Ste F, Costa Mesa, CA 92627-3536 | 2009-06-11 |
| 1003961749 | Jeremy Elkins | Physician Assistant | 1550 Superior Ave, Costa Mesa, CA 92627-3653 | 2007-01-24 |
| 1093891061 | Tiffany Le | Physician Assistant | 700 W 19th St, Costa Mesa, CA 92627-3517 | 2006-10-31 |
| Find all providers in COSTA MESA | ||||
| City | COSTA MESA |
| Zip Code | 92626 |
Please comment or provide details below to improve the information on NELAE JONTUE KEENE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.