Provider Demographics
NPI:1972249738
Name:ALAZARD, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ALAZARD
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 1:10151 PINECASTLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2291
Mailing Address - Country:US
Mailing Address - Phone:858-761-6748
Mailing Address - Fax:
Practice Address - Street 1:4635 MISSION GORGE PL STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4145
Practice Address - Country:US
Practice Address - Phone:619-501-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist