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NPI Code Detail

MEDICARE: ANGELITA GABRIELLE KELLY

MEDICARE: ANGELITA GABRIELLE KELLY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1447118690
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELITA GABRIELLE KELLY
Provider Business Mailing Address
First Line : 1016 E GHENT ST
Second Line :
City : AZUSA
State : CA
Zip : 91702-4834
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 177 E COLORADO BLVD STE 200
Second Line :
City : PASADENA
State : CA
Zip : 91105-1955
Country : US
Telephone Number : 626-421-7960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2026
Last Update Date : 01/14/2026

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Directions to “ ANGELITA GABRIELLE KELLY ” Practice Location

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