Provider Demographics
NPI:1679609283
Name:DELOZIER, KELLIE A (MD)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:A
Last Name:DELOZIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSB STUDENT HEALTH
Mailing Address - Street 2:SERVICE BUILDING 588, M/C 7002
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-7002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UCSB STUDENT HEALTH
Practice Address - Street 2:SERVICE BUILDING 588, M/C 7002
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-893-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55521207V00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB242139OtherMEDICARE ID
NVV101788Medicare PIN
NV100507581Medicaid