Healthcare Provider Details

I. General information

NPI: 1689201279
Provider Name (Legal Business Name): ALEXANDRA GABRIELLE KELLEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. GABRIELLE KELLEY

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A20847
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: