Healthcare Provider Details

I. General information

NPI: 1013622844
Provider Name (Legal Business Name): KELVIN DONYELL FLEMING SR. MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 RIESLING ST
HEMET CA
92545-6362
US

IV. Provider business mailing address

763 RIESLING ST
HEMET CA
92545-6362
US

V. Phone/Fax

Practice location:
  • Phone: 951-447-3744
  • Fax:
Mailing address:
  • Phone: 951-447-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: