Healthcare Provider Details

I. General information

NPI: 1740309608
Provider Name (Legal Business Name): M. BARBARA KLYDE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W KATELLA AVE
ANAHEIM CA
92804-6450
US

IV. Provider business mailing address

2391 N RIVER TRAIL RD
ORANGE CA
92865-2036
US

V. Phone/Fax

Practice location:
  • Phone: 714-400-2959
  • Fax:
Mailing address:
  • Phone: 171-492-1896
  • Fax: 171-463-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 10707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: