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NPI Code Detail

MEDICARE: BRIAN EDWARD KELLY MSW

MEDICARE: BRIAN EDWARD KELLY MSW
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
1104100000XSocial Worker118768TX

General Provider Information

NPI Number : 1770861924
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN EDWARD KELLY MSW
Provider Business Mailing Address
First Line : 8875 AERO DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-2251
Country : US
Telephone Number : 619-400-5000
Fax Number :
Provider Business Practice Location Address
First Line : 8875 AERO DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-2251
Country : US
Telephone Number : 619-400-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2011
Last Update Date : 04/27/2026

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