Healthcare Provider Details

I. General information

NPI: 1841063435
Provider Name (Legal Business Name): KYRA JESSICA WOJCIK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE STE 230
PASADENA CA
91105-2663
US

IV. Provider business mailing address

625 S FAIR OAKS AVE STE 230
PASADENA CA
91105-2663
US

V. Phone/Fax

Practice location:
  • Phone: 626-469-2939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: