Provider Demographics
NPI:1841765815
Name:CONTRERAS, KELLY MARIE
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:MARIE
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KC
Other - Middle Name:
Other - Last Name:CONTRERAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAL BILLER / COL
Mailing Address - Street 1:902 N. GRAND AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-613-0029
Mailing Address - Fax:714-558-9803
Practice Address - Street 1:902 N. GRAND AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-613-0029
Practice Address - Fax:714-558-9803
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory