Provider Demographics
NPI:1659779155
Name:NAVEEN KELLA MD PA
Entity Type:Organization
Organization Name:NAVEEN KELLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-617-3670
Mailing Address - Street 1:9618 HUEBNER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1775
Mailing Address - Country:US
Mailing Address - Phone:210-617-3670
Mailing Address - Fax:888-316-9464
Practice Address - Street 1:9618 HUEBNER ROAD , SUITE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1660
Practice Address - Country:US
Practice Address - Phone:210-617-3670
Practice Address - Fax:888-316-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty