Provider Demographics
NPI:1730460130
Name:RAY, KELLI ELISSE
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ELISSE
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 ALLSTON WAY
Mailing Address - Street 2:H-105
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1463
Mailing Address - Country:US
Mailing Address - Phone:510-644-6965
Mailing Address - Fax:
Practice Address - Street 1:1980 ALLSTON WAY
Practice Address - Street 2:H-105
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1463
Practice Address - Country:US
Practice Address - Phone:510-644-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator