Individual
DR. JAKE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 SCOFIELD AVE, WASCO, CA 93280-7515
(661) 758-8400
Mailing address
425 ESTANCIA, IRVINE, CA 92602-1108
(408) 505-0654
Taxonomy
Speciality
Code
Description
License number
State
103TF0200X
Forensic Psychologist
Primary
—
—
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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