Healthcare Provider Details

I. General information

NPI: 1578343729
Provider Name (Legal Business Name): KELSEY REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

15430 FOOTHILL BLVD
CASTRO VALLEY CA
94578-1009
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax:
Mailing address:
  • Phone: 510-335-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: