NPI 1003479320

Manny Brice Kelly, LPT

Practitioner Licensed Psychiatric Technician San Bernardino, CA

Practice location

Address: 1481 Windsor Dr, San Bernardino, CA 92404-5416
Phone: (909) 361-6472
Fax: (909) 203-7403
Mailing address: 2895 W Fairview Dr, Rialto, CA 92377-3425

Registered specialties

Licensed Psychiatric Technician Primary

Nursing Service Providers Taxonomy 167G00000X Licence 33817 (CA)

Other Licensed Psychiatric Technician providers in California →

Registry record

NPI: 1003479320
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Apr 2019
Record last updated: 22 Apr 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.