Individual
KYLA AMA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2141 N HARBOR BLVD STE 35000, FULLERTON, CA 92835-3831
(714) 626-8630
Mailing address
PO BOX 1810, RANCHO MIRAGE, CA 92270-1059
(760) 568-2684
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA 9104116
FL
363AM0700X
Medical Physician Assistant
Primary
PA19190
CA
363AS0400X
Surgical Physician Assistant
PA19190
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AW012X
MEDICARE PTAN
CA
01
—
AW012Y
MEDICARE PTAN
CA
01
—
AW012Z
MEDICARE PTAN
CA
Enumeration date
04/10/2007
Last updated
10/19/2020
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