Individual
SCOTT ANDREW KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
242 AVENIDA PELAYO UNIT A, SAN CLEMENTE, CA 92672-5033
(773) 491-2746
Mailing address
242 AVENIDA PELAYO UNIT A, SAN CLEMENTE, CA 92672-5033
(773) 491-2746
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/29/2020
Last updated
01/29/2020
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