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Individual

MIKAELA LA VITA KAESS

Active
Sole proprietor
No

Provider details

NPI number
Gender
X
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(602) 344-5011
Mailing address
4101 W UNION HILLS DR APT 1089, GLENDALE, AZ 85308-1733
(302) 561-1099

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11183
AZ

Other

Enumeration date
08/05/2025
Last updated
08/05/2025
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