Individual
MR. MICHAEL SEAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
17601 17TH ST STE 120, TUSTIN, CA 92780-1946
(714) 769-6090
Mailing address
215 SANTA ISABEL AVE, COSTA MESA, CA 92627-1509
(949) 722-7118
(949) 722-7119
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95001913
CA
Other
Enumeration date
01/28/2015
Last updated
01/24/2019
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