Healthcare Provider Details

I. General information

NPI: 1669186581
Provider Name (Legal Business Name): KAYLA ALEXIS ARANTOWICZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 MIDWAY DR STE 2001
SAN DIEGO CA
92110-4924
US

IV. Provider business mailing address

10565 CIVIC CENTER DR STE 250
RANCHO CUCAMONGA CA
91730-3854
US

V. Phone/Fax

Practice location:
  • Phone: 619-325-1161
  • Fax: 619-325-1717
Mailing address:
  • Phone: 626-696-1400
  • Fax: 626-696-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number64647
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: