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1003206004
MICHAEL SEAN KELLY
TUSTIN, CA
NPI
1003206004
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CA 95001913)
Enumeration Date
2015-01-28
Last Update Date
2019-01-24
Business Address
Mr. MICHAEL SEAN KELLY NP
17601 17TH ST STE 120
TUSTIN, CA 92780-1946
Phone number: 714-769-6090
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Mailing Address
Mr. MICHAEL SEAN KELLY NP
215 SANTA ISABEL AVE
COSTA MESA, CA 92627-1509
Phone number: 949-722-7118
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