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General NPI Number Information
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NPI Number | 1316345382
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Entity Type | Individual
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Provider Name | MRS. KELLY CHRISTINE O'NEILL
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Gender | Female
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 16767 BERNARDO CENTER DR. L1#270289
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City | SAN DIEGO
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State | CA
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Zip | 92198
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Country | US
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Telephone | 888-748-4057
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1477
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City | LAGUNA BEACH
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State | CA
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Zip | 92652-1477
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Country | US
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Telephone | 949-290-6505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY17350
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License Number State | CA
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