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General NPI Number Information
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NPI Number | 1649483884
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Entity Type | Individual
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Provider Name | JONATHAN GEOFFREY KELLING M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 38860 SKY CANYON DR BLDG A
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City | MURRIETA
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State | CA
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Zip | 92563-2540
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Country | US
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Telephone | 951-375-7972
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Fax | 877-657-8718
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Provider Business Mailing Address
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Address Line | 38860 SKY CANYON DR BLDG A
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City | MURRIETA
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State | CA
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Zip | 92563-2540
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Country | US
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Telephone | 951-375-7972
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Fax | 877-657-8718
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | A97287
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A97287
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License Number State | CA
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