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General NPI Number Information
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NPI Number | 1386998219
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Entity Type | Individual
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Provider Name | WALTER KELLY H.I.S.
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Gender | Male
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 333 H ST STE 5000
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City | CHULA VISTA
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State | CA
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Zip | 91910-5561
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Country | US
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Telephone | 619-349-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 333 H STREET
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City | CHULA VISTA
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State | CA
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Zip | 91910
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Country | US
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Telephone | 619-349-5410
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA7495
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License Number State | CA
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