Individual
MARY JANE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1046 E ELGENIA AVE, WEST COVINA, CA 91790-1318
(626) 862-5686
Mailing address
1046 E ELGENIA AVE, WEST COVINA, CA 91790-1318
(626) 862-5686
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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