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NPI Code Detail

MEDICARE: KELLY PSYCHIATRIC ASSOCIATES, INC.

MEDICARE: KELLY PSYCHIATRIC ASSOCIATES, 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
12084P0804XChild & Adolescent Psychiatry Physician
22084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1821515818
Entity Type Code : Organization
Provider Name (Legal Business Name) : KELLY PSYCHIATRIC ASSOCIATES, INC.
Provider Business Mailing Address
First Line : 1230 ROSECRANS AVE STE 300
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2494
Country : US
Telephone Number : 424-269-0086
Fax Number : 844-868-3841
Provider Business Practice Location Address
First Line : 1230 ROSECRANS AVE STE 300
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2494
Country : US
Telephone Number : 424-269-0086
Fax Number : 844-868-3841
Authorized Official
Title or Position : PRESIDENT
Name : DR. PATRICK MICHAEL KELLY
Credential : MD
Telephone Number : 424-269-0086
Provider Enumeration Date : 08/29/2017
Last Update Date : 01/18/2024

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