Healthcare Provider Details

I. General information

NPI: 1770471153
Provider Name (Legal Business Name): ISABELLA KAMILA KALLO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 E MYRTLE AVE STE 400
PHOENIX AZ
85020-5514
US

IV. Provider business mailing address

1635 E MYRTLE AVE STE 400 400
PHOENIX AZ
85020-5514
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-2900
  • Fax:
Mailing address:
  • Phone: 602-944-2900
  • Fax: 602-944-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: