Provider Demographics
NPI:1215086772
Name:CORBETT, KELLY MARY (LAC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARY
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2403
Mailing Address - Country:US
Mailing Address - Phone:415-431-1825
Mailing Address - Fax:415-431-1825
Practice Address - Street 1:214 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2403
Practice Address - Country:US
Practice Address - Phone:415-431-1825
Practice Address - Fax:415-431-1825
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2472171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist