Healthcare Provider Details

I. General information

NPI: 1376488577
Provider Name (Legal Business Name): KELKER PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E WASHINGTON ST
COLTON CA
92324-4624
US

IV. Provider business mailing address

1550 E WASHINGTON ST
COLTON CA
92324-4624
US

V. Phone/Fax

Practice location:
  • Phone: 310-810-6554
  • Fax: 310-810-6554
Mailing address:
  • Phone: 310-810-6554
  • Fax: 310-810-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TARIQ KELKER
Title or Position: CEO
Credential: MD
Phone: 310-810-6554