Individual
DEMETRI RASHAD KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11519 CARLISLE PL, RANCHO CUCAMONGA, CA 91730-7233
(909) 484-7259
Mailing address
16258 LADYBIRD WAY, FONTANA, CA 92336-5828
(760) 605-4778
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/10/2022
Last updated
08/10/2022
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