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NPI Code Detail

MEDICARE: BRIELLE E KELLY L.AC., DIPL.O.M.

MEDICARE: BRIELLE E KELLY L.AC., DIPL.O.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturist001912NY
2171100000XAcupuncturist10375CA

General Provider Information

NPI Number : 1164509253
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIELLE E KELLY L.AC., DIPL.O.M.
Provider Business Mailing Address
First Line : 10 EL CAMINO REAL
Second Line : SUITE 202
City : SAN CARLOS
State : CA
Zip : 94070-2451
Country : US
Telephone Number : 650-596-5616
Fax Number : 650-596-5653
Provider Business Practice Location Address
First Line : 10 EL CAMINO REAL
Second Line : SUITE 202
City : SAN CARLOS
State : CA
Zip : 94070-2451
Country : US
Telephone Number : 650-596-5616
Fax Number : 650-596-5653
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 10/28/2014

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