MEDICARE: DR. LAUREN KELLEY D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	20A24137	CA

General Provider Information

NPI Number	:	1760725543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN KELLEY D.O

Provider Business Mailing Address
First Line	:	302 WASHINGTON ST STE 310
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2110
Country	:	US
Telephone Number	:	858-333-6636
Fax Number	:	858-321-2189

Provider Business Practice Location Address
First Line	:	3225 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5701
Country	:	US
Telephone Number	:	858-333-6636
Fax Number	:	858-321-2189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2013
Last Update Date	:	06/15/2026

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