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General NPI Number Information
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NPI Number | 1922328434
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Entity Type | Individual
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Provider Name | WALTER KELLY BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 701 PALOMAR AIRPORT RD STE 300
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City | CARLSBAD
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State | CA
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Zip | 92011-1028
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Country | US
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Telephone | 760-434-4327
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Fax | 858-437-9924
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Provider Business Mailing Address
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Address Line | 701 PALOMAR AIRPORT RD STE 300
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City | CARLSBAD
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State | CA
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Zip | 92011-1028
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Country | US
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Telephone | 760-434-4327
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Fax | 858-437-9924
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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 | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | CAHA2450
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HAS218
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA 2450
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License Number State | CA
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