Provider Demographics
NPI:1366684037
Name:KENNEDY, AELITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AELITA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AELITA
Other - Middle Name:
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12370 HESPERIA RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7719
Mailing Address - Country:US
Mailing Address - Phone:760-245-4747
Mailing Address - Fax:760-261-6451
Practice Address - Street 1:12370 HESPERIA RD
Practice Address - Street 2:SUITE 6
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7719
Practice Address - Country:US
Practice Address - Phone:760-245-4747
Practice Address - Fax:760-261-6451
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine