Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A78913 | CA |
NPI | 1194733402 |
---|---|
Provider Name | Dr. Steven Thomas Kelley |
First Address | Temecula, CA 92591-6031 |
Second Address | Temecula, CA 92591-6031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 07/06/2012 |