Provider Demographics
NPI:1386994044
Name:CONESA, KELLI NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:NICOLE
Last Name:CONESA
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1661 SW 37TH AVE
Mailing Address - Street 2:#102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1754
Mailing Address - Country:US
Mailing Address - Phone:305-663-3265
Mailing Address - Fax:305-663-2698
Practice Address - Street 1:1661 SW 37TH AVE
Practice Address - Street 2:#102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1754
Practice Address - Country:US
Practice Address - Phone:305-663-3265
Practice Address - Fax:305-663-2698
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC4742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist