Provider Demographics
NPI:1023408093
Name:KELLMAN, BEVERLEY
Entity type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:KELLMAN
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 1:7240 BAY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3412
Mailing Address - Country:US
Mailing Address - Phone:909-227-6859
Mailing Address - Fax:951-479-8199
Practice Address - Street 1:7240 BAY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3412
Practice Address - Country:US
Practice Address - Phone:909-227-6859
Practice Address - Fax:951-479-8199
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist