Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101021134 | MI |
Y | 207Q00000X | Family Doctor | 20A18772 | CA |
N | 207Q00000X | Family Doctor | 5101021134 | MI |
NPI | 1578977336 |
---|---|
Provider Name | Kelley Brinsky |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Belmont, CA 94002-4110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 07/09/2021 |