Individual
KELLI GORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
41870 GARSTIN RD., BIG BEAR LAKE, CA 92315
(909) 878-8294
Mailing address
1141 LA LOMA DR, SANTA ANA, CA 92705-2902
(714) 335-4113
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95000429
CA
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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