Provider Demographics
NPI:1962732784
Name:KELLY, ANGELA (BS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3839
Mailing Address - Country:US
Mailing Address - Phone:562-889-8987
Mailing Address - Fax:562-802-3644
Practice Address - Street 1:801 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3839
Practice Address - Country:US
Practice Address - Phone:562-996-2323
Practice Address - Fax:562-802-3644
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker