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Individual

CARYN JOY AXTELL-KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
13193 CENTRAL AVE, SUITE 220, CHINO, CA 91710
(909) 591-0843
(909) 591-7226
Mailing address
PO BOX 2492, RANCHO CUCAMONGA, CA 91729-2492
(909) 591-0843
(909) 591-7226

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA17278
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PA17278
CA
Enumeration date
07/01/2006
Last updated
03/07/2008
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