Most Relevant Information
Provider Data
| NPI Number: | 1003206004 |
| Provider Name: | MICHAEL SEAN KELLY NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 95001913 |
Most Important Dates
| Enumeration Date: | 01/28/2015 |
| Last Updated: | 01/24/2019 |
Provider Practice Location
17601 17TH ST STE 120
TUSTIN
CA
927801946
Practice Location Phone/Fax
| Phone: | 7147696090 |
| Fax: |
Provider Mailing Location
215 SANTA ISABEL AVE
COSTA MESA
CA
926271509
Provider Mailing Phone/Fax
| Phone: | 9497227118 |
| Fax: | 9497227119 |