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General NPI Number Information
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NPI Number | 1972963262
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Entity Type | Individual
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Provider Name | KELLY BYRER
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 861 HAROLD PL SUITE 205
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City | CHULA VISTA
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State | CA
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Zip | 91914-4553
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Country | US
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Telephone | 619-578-2232
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Fax | 619-578-2231
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Provider Business Mailing Address
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Address Line | 7850 MISSION CENTER CT SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92108-1322
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Country | US
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Telephone | 619-578-2232
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Fax | 619-578-2231
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SPA 3664
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License Number State | CA
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