Healthcare Provider Details

I. General information

NPI: 1093464679
Provider Name (Legal Business Name): KAYLA LAUREN STUDACH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA BROOKS PA

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 E SPRING ST
LONG BEACH CA
90815-1423
US

IV. Provider business mailing address

1401 AVOCADO AVE
NEWPORT BEACH CA
92660-7720
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-6543
  • Fax:
Mailing address:
  • Phone: 949-706-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-61322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: