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NPI Code Detail

MEDICARE: KELLY OBERIA ELMORE M.D.

MEDICARE: KELLY OBERIA ELMORE M.D.
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
1207V00000XObstetrics & Gynecology PhysicianA105818CA

General Provider Information

NPI Number : 1942274964
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY OBERIA ELMORE M.D.
Provider Business Mailing Address
First Line : 5680 TRINIDAD WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92114-5310
Country : US
Telephone Number : 773-398-6867
Fax Number :
Provider Business Practice Location Address
First Line : 445 S FIGUEROA ST FL 31
Second Line :
City : LOS ANGELES
State : CA
Zip : 90071-1602
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/22/2024

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