Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | G71281 | CA |
NPI | 1174687560 |
---|---|
Provider Name | Dr. Frederick Kelley |
First Address | Ventura, CA 93009-3099 |
Second Address | Santa Paula, CA 93060-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 21/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71281 | (02) | CA |