| Kelly Tonelli Psychologist A Professional Corporation | |
|
10 Corporate Park Ste 215 Irvine CA 92606-5199 | |
| (949) 444-6486 | |
| Not Available |
| Full Name | Kelly Tonelli Psychologist A Professional Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 10 Corporate Park Ste 215, Irvine, California |
| Authorized Official Name and Position | Kelly Tonelli (PRESIDENT) |
| Authorized Official Contact | 9492623248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Tonelli Psychologist A Professional Corporation 10 Corporate Park Ste 215 Irvine CA 92606-5199 Ph: (949) 444-6486 | Kelly Tonelli Psychologist A Professional Corporation 10 Corporate Park Ste 215 Irvine CA 92606-5199 Ph: (949) 444-6486 |
| NPI Number | 1730481789 |
|---|---|
| Provider Enumeration Date | 11/24/2010 |
| Last Update Date | 12/11/2023 |
| Certification Date | 11/27/2023 |
| Medicare PECOS PAC ID | 0840649265 |
|---|---|
| Medicare Enrollment ID | O20231211003205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730481789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY 19248 (California) | Primary |
| Provider Name | Kelly L Tonelli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407070386 PECOS PAC ID: 0840206470 Enrollment ID: I20231211003231 |
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