Individual
KELLY DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(619) 740-4500
(619) 740-8499
Mailing address
PO BOX 509015, DEPT 338, SAN DIEGO, CA 92150-9015
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A74873
CA
2085R0001X
Radiation Oncology Physician
Primary
A74873
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A748730
—
CA
01
—
A74873
MEDICAL LICENSE
CA
Enumeration date
06/15/2006
Last updated
02/18/2026
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