Individual
MS. JADE MIDORI KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3020 CHILDRENS WAY, SAN DIEGO, CA 92123-4223
(858) 576-1700
Mailing address
1135 HEMLOCK AVE, IMPERIAL BEACH, CA 91932-3520
(619) 207-9180
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86106236
CA
Other
Enumeration date
12/17/2019
Last updated
12/17/2019
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