Healthcare Provider Details

I. General information

NPI: 1427712900
Provider Name (Legal Business Name): KAYLA ROSALYN COOPER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11669 SANTA MONICA BLVD STE 110
LOS ANGELES CA
90025-2929
US

IV. Provider business mailing address

11669 SANTA MONICA BLVD STE 110
LOS ANGELES CA
90025-2929
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-4989
  • Fax: 310-998-3282
Mailing address:
  • Phone: 310-315-4989
  • Fax: 310-998-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: