Individual
MR. ANTHONY DESANTO-KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSE PYSCH TECH 3
Contact information
Practice address
3501 N LAKEWOOD BLVD, LONG BEACH, CA 90808-1736
(562) 570-7119
Mailing address
12857 FREDERICK ST APT 304, MORENO VALLEY, CA 92553-4502
(951) 653-3141
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT24452
CA
Other
Enumeration date
10/13/2006
Last updated
07/08/2007
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