Individual
DR. KELLY L LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
9606 TIERRA GRANDE ST, SUITE 107, SAN DIEGO, CA 92126-6501
(858) 693-3113
Mailing address
9606 TIERRA GRANDE ST, SUITE 107, SAN DIEGO, CA 92126-6501
(858) 693-3113
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY21401
CA
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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