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General NPI Number Information
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NPI Number | 1679752505
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Entity Type | Organization
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Legal Business Name | BRIELLE E. KELLY, L.AC., INC.
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Dates
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Enumeration Date | 10/27/2007
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 10 EL CAMINO REAL SUITE 202
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City | SAN CARLOS
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State | CA
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Zip | 94070-2451
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Country | US
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Telephone | 650-596-5616
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Fax |
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Provider Business Mailing Address
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Address Line | 10 EL CAMINO REAL SUITE 202
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City | SAN CARLOS
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State | CA
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Zip | 94070-2451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/DIRECTOR
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Name | BRIELLE KELLY
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Credential | L.AC., DIPL.O.M
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Telephone | 65025965616
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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 | 10375
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License Number State | CA
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