Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | A91532 | CA |
NPI | 1134307713 |
---|---|
Provider Name | Dr. Robert Brett Kelly |
First Address | Orange, CA 92868-4203 |
Second Address | Orange, CA 92868-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2008 |
Last Update Date | 04/02/2019 |