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General NPI Number Information
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NPI Number | 1518287515
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Entity Type | Individual
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Provider Name | LAURA ELIZABETH KELLY L.AC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 02/15/2015
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Provider Practice Location Address
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Address Line | 19616 WALNUT TRL
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City | TOPANGA
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State | CA
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Zip | 90290-3120
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Country | US
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Telephone | 310-592-9382
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Fax |
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Provider Business Mailing Address
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Address Line | 19616 WALNUT TRL
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City | TOPANGA
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State | CA
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Zip | 90290-3120
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Country | US
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Telephone | 310-592-9382
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 13568
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License Number State | CA
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