MEDICARE: JEILA MARIE KAKAVAND PA-C

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	363A00000X	Physician Assistant	52220	CA

General Provider Information

NPI Number	:	1790127298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEILA MARIE KAKAVAND PA-C

Provider Business Mailing Address
First Line	:	477 N EL CAMINO REAL STE B301
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-1331
Country	:	US
Telephone Number	:	760-753-1104
Fax Number	:	760-943-6494

Provider Business Practice Location Address
First Line	:	3998 VISTA WAY STE 108
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4515
Country	:	US
Telephone Number	:	760-941-7336
Fax Number	:	760-943-6494

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	01/22/2026

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