Healthcare Provider Details

I. General information

NPI: 1053278671
Provider Name (Legal Business Name): MCKAYLA PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-4087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberINT50022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: