Healthcare Provider Details

I. General information

NPI: 1700374469
Provider Name (Legal Business Name): KELLIE D SPECTOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S MAIN ST # 485
ORANGE CA
92868-3813
US

IV. Provider business mailing address

8700 BEVERLY BLVD STE 5512
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-4800
  • Fax: 714-835-1900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA165496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: