MEDICARE: KAYLEE RAE PARSONS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	20A16740	CA

General Provider Information

NPI Number	:	1174056402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEE RAE PARSONS D.O.

Provider Business Mailing Address
First Line	:	11234 ANDERSON ST
Second Line	:	GME OFFICE WESTERLY SUITE 'C'
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD STE 713
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1921
Country	:	US
Telephone Number	:	714-542-1331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	09/28/2020

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