Provider Demographics
NPI:1215746490
Name:EBERLY, KELLI J
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:EBERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24910 LAS BRISAS RD STE 117
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4035
Mailing Address - Country:US
Mailing Address - Phone:951-465-3664
Mailing Address - Fax:951-972-8551
Practice Address - Street 1:24910 LAS BRISAS RD STE 117
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4035
Practice Address - Country:US
Practice Address - Phone:951-465-3664
Practice Address - Fax:951-972-8551
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker