Individual
ELYSE KIELE KOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1199 LANTANA ST, CAMARILLO, CA 93010-3024
(805) 914-9503
Mailing address
1199 LANTANA ST, CAMARILLO, CA 93010-3024
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1223458
NY
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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