Most Relevant Information
Provider Data
| NPI Number: | 1003479320 |
| Provider Name: | MANNY BRICE KELLY LPT |
| Entity Type: | Individual |
| Taxonomy Code: | 167G00000X |
| Specialty: | Licensed Psychiatric Technician |
| License Number: | 33817 |
Most Important Dates
| Enumeration Date: | 04/22/2019 |
| Last Updated: | 04/22/2019 |
Provider Practice Location
1481 WINDSOR DR
SAN BERNARDINO
CA
924045416
Practice Location Phone/Fax
| Phone: | 9093616472 |
| Fax: | 9092037403 |
Provider Mailing Location
2895 W FAIRVIEW DR
RIALTO
CA
923773425
Provider Mailing Phone/Fax
| Phone: | 9094355341 |
| Fax: |