Provider Demographics
NPI:1942274964
Name:ELMORE, KELLY OBERIA (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:OBERIA
Last Name:ELMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:5680 TRINIDAD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-5310
Mailing Address - Country:US
Mailing Address - Phone:773-398-6867
Mailing Address - Fax:
Practice Address - Street 1:445 S FIGUEROA ST FL 31
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-1602
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105818207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology