Healthcare Provider Details

I. General information

NPI: 1982100244
Provider Name (Legal Business Name): KELLY CUYJET
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CARDINAL LN
SAN DIEGO CA
92123-3743
US

IV. Provider business mailing address

2351 CARDINAL LN
SAN DIEGO CA
92123-3743
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-2227
  • Fax:
Mailing address:
  • Phone: 858-573-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: