Healthcare Provider Details

I. General information

NPI: 1154299014
Provider Name (Legal Business Name): KYLA MARIE CHAVEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S DOBSON RD STE 202
MESA AZ
85202-4724
US

IV. Provider business mailing address

18444 N 25TH AVE STE 310
PHOENIX AZ
85023-1266
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-2673
  • Fax: 866-939-2673
Mailing address:
  • Phone: 623-241-8741
  • Fax: 480-499-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11579
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: