MR. MICHAEL SEAN KELLY (NPI# 1003206004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003206004 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL SEAN KELLY |
| Credential | NP |
| Practice Address |
17601 17th St Ste 120 Tustin CA 92780-1946 |
| Mailing Address |
215 Santa Isabel Ave Costa Mesa CA 92627-1509 |
| Practice Telephone | 7147696090 |
| Mailing Telephone | 9497227118 |
| Mailing Fax Number | 9497227119 |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2019-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
95001913 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 275 Victoria St, Costa Mesa, CA 926271906 | 9497227118 | 9497227118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699389874 | Michael Kelly | Physical Therapist | 1025 Service Pl Ste 200, Vista, CA 92084-7271 | 2020-09-03 |
| 1871949115 | Michael John Kelly | Speech-Language Pathologist | 3484 Fair Oaks Ave, Bowling Green, KY 42104-5529 | 2016-05-05 |
| 1295135515 | Michael Kelly | Technician, Other | 2215 E 36 1/2 St, Minneapolis, MN 55407-3018 | 2014-08-25 |
| 1225310675 | Michael Thomas Kelly | Pathology | 4156 H Street Rd, Blaine, WA 98230-9228 | 2011-09-12 |
| 1205085073 | Michael H Kelly | Massage Therapist | 76 Bosse Ln, West Seneca, NY 14224-1624 | 2008-09-16 |
| 1275780041 | Michael Foster Kelly | Acupuncturist | 8 Wells Ave, Yonkers, NY 10701-2710 | 2008-08-25 |
| 1346458031 | Michael Francis Kelly | Registered Nurse | 79 Trausneck Pl, Yonkers, NY 10703-1907 | 2007-05-18 |
| 1104045707 | Michael Walter Kelly | Pharmacist | College of Pharmacy, 110 Pharmacy Building, Iowa City, IA 52242-1112 | 2007-04-24 |
| 1710105358 | Michael Kelly | Physical Therapist | 1600 E. Jefferson St., Seattle, WA 98122 | 2007-04-20 |
| 1326262734 | Michael James Kelly | Pediatrics | 800 Washington St # 14, Boston, MA 02111-1552 | 2007-04-13 |
| Street Address |
17601 17TH ST STE 120 |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-1946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386146496 | Alliance Psychiatric Group Inc A Medical Corporation | Nurse Practitioner | 17601 17th St Ste 120, Tustin, CA 92780-1946 | 2018-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
| Find all providers in zip 92780 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386146496 | Alliance Psychiatric Group Inc A Medical Corporation | Nurse Practitioner | 17601 17th St Ste 120, Tustin, CA 92780-1946 | 2018-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154573 | Marcus Jang | Nurse Practitioner | 1130 E Colorado St Apt 214, Glendale, CA 91205-2092 | 2020-11-04 |
| 1033718580 | John Sylvanus Allieu Sr. | Nurse Practitioner | 2672 Merganser Ct, Los Banos, CA 93635-9473 | 2020-10-25 |
| 1316546930 | Chika U Oguagha | Nurse Practitioner | 16240 Carmine St, Fontana, CA 92336-1481 | 2020-10-23 |
| 1215534888 | Rosa Maria Aguero | Nurse Practitioner | 9841 Alburtis Ave Unit 29, Santa Fe Springs, CA 90670-3264 | 2020-10-06 |
| 1134726995 | Margarita Maghtesyan | Nurse Practitioner | 20251 Ventura Blvd Ste A, Woodland Hills, CA 91364-2564 | 2020-10-05 |
| 1043827140 | April Lopez Ortiz | Nurse Practitioner | 500 W Ashland Ct, Visalia, CA 93277-6609 | 2020-09-23 |
| 1477167666 | David Joseph Russell | Nurse Practitioner | 17846 Glenwood Rd, Manteca, CA 95336-9521 | 2020-09-03 |
| 1194339382 | Albert Liu | Nurse Practitioner | 43559 Southerland Way, Fremont, CA 94539-5931 | 2020-09-03 |
| 1407469554 | Andre Alexandrian | Nurse Practitioner | 1606 Winona Ave, Burbank, CA 91504-2823 | 2020-08-28 |
| 1790398238 | Heather Richardson | Nurse Practitioner | 112 S Park St Ste 1, San Francisco, CA 94107-1809 | 2020-08-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.