Healthcare Provider Details

I. General information

NPI: 1497127658
Provider Name (Legal Business Name): KAYLA HAMRICK LUSSIER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

IV. Provider business mailing address

27450 YNEZ RD STE 100
TEMECULA CA
92591-4649
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-4333
  • Fax: 951-506-2361
Mailing address:
  • Phone: 951-383-4333
  • Fax: 801-812-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8149392-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: