Individual
COLLEEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3030 CHILDRENS WAY, SAN DIEGO, CA 92123-4232
(858) 966-8974
Mailing address
3020 CHILDRENS WAY, MC5096, SAN DIEGO, CA 92123-4223
(858) 966-8974
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95002304
CA
Other
Enumeration date
09/24/2015
Last updated
11/18/2016
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