Healthcare Provider Details

I. General information

NPI: 1659217586
Provider Name (Legal Business Name): KAMAYA MICHELLE KILLEBREW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5365 WALNUT AVE STE A
CHINO CA
91710-2622
US

IV. Provider business mailing address

33 ROSA
RANCHO SANTA MARGARITA CA
92688-1402
US

V. Phone/Fax

Practice location:
  • Phone: 909-575-0055
  • Fax:
Mailing address:
  • Phone: 760-994-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberPA67898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: