Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 156668 | CA |
NPI | 1003200171 |
---|---|
Provider Name | William Kelly |
First Address | Santa Maria, CA 93458-7310 |
Second Address | Lompoc, CA 93436-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 06/08/2018 |