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NPI Code Detail

MEDICARE: BRIELLE E. KELLY, L.AC., INC.

MEDICARE: BRIELLE E. KELLY, L.AC., INC.
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
1171100000XAcupuncturist10375CA

General Provider Information

NPI Number : 1679752505
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIELLE E. KELLY, L.AC., INC.
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 :
Fax Number :
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 :
Authorized Official
Title or Position : ACUPUNCTURIST/DIRECTOR
Name : BRIELLE KELLY
Credential : L.AC., DIPL.O.M
Telephone Number : 65025965616
Provider Enumeration Date : 10/27/2007
Last Update Date : 04/14/2016

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