Healthcare Provider Details

I. General information

NPI: 1023929767
Provider Name (Legal Business Name): KELSEY GUADALUPE BRICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 CENTER COURT DRIVE SUITE 211
COVINA CA
91724
US

IV. Provider business mailing address

1274 CENTER COURT DRIVE SUITE 211
COVINA CA
91724
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-4999
  • Fax:
Mailing address:
  • Phone: 626-339-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberW9638674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: