Healthcare Provider Details

I. General information

NPI: 1508624628
Provider Name (Legal Business Name): KAYLIN OKUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

5555 GROSSMONT CENTER DR # A217
LA MESA CA
91942-3019
US

V. Phone/Fax

Practice location:
  • Phone: 619-741-4452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: