Provider Demographics
NPI:1053728915
Name:BECKMAN, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BECKMAN
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 1:5677 OBERLIN DR
Mailing Address - Street 2:ST 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1740
Mailing Address - Country:US
Mailing Address - Phone:858-457-8419
Mailing Address - Fax:858-457-0670
Practice Address - Street 1:5677 OBERLIN DR
Practice Address - Street 2:ST 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1740
Practice Address - Country:US
Practice Address - Phone:858-457-8419
Practice Address - Fax:858-457-0670
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17848171100000X
CA58164225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist