Healthcare Provider Details

I. General information

NPI: 1265970248
Provider Name (Legal Business Name): BENJAMEN KYLE LOSOYA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15477 VENTURA BLVD STE 101
SHERMAN OAKS CA
91403-3047
US

IV. Provider business mailing address

8444 SPECTRUM DR
MCKINNEY TX
75072-5864
US

V. Phone/Fax

Practice location:
  • Phone: 818-330-5501
  • Fax:
Mailing address:
  • Phone: 850-292-6313
  • Fax: 850-292-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA54267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: