| Doctor Name: | KELLY DEWITT |
| NPI Number: | 1184668741 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | A74873 |
| Business Practice Address: | 5555 Grossmont Center Dr La Mesa, CA - 919423019 |
| Business Phone Number: | 6196444500 |
| Business Fax Number: | 6196444547 |
| Mailing Address: | Po Box 710490, SAN DIEGO |
| State: | CA |
| Postal Code: | 921710490 |
| Phone Number: | 8582560351 |
| Fax Number: | 8582560355 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 02/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | A74873 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |