Provider Demographics
NPI:1972791341
Name:AUSTIN, KELLY (ND)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 BERNARDO PLAZA CT STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2402
Mailing Address - Country:US
Mailing Address - Phone:858-675-7072
Mailing Address - Fax:858-348-2005
Practice Address - Street 1:11828 BERNARDO PLAZA CT STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2402
Practice Address - Country:US
Practice Address - Phone:858-757-0726
Practice Address - Fax:858-348-2005
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath