Healthcare Provider Details

I. General information

NPI: 1497514681
Provider Name (Legal Business Name): KAYLEA ANN PHILOBOS NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BREA BLVD STE 210
FULLERTON CA
92835-4128
US

IV. Provider business mailing address

204 E CLEVELAND ST
PRAIRIE GROVE AR
72753-3208
US

V. Phone/Fax

Practice location:
  • Phone: 714-732-1773
  • Fax:
Mailing address:
  • Phone: 626-848-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: