Healthcare Provider Details

I. General information

NPI: 1053205732
Provider Name (Legal Business Name): KAYLA MARIE ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MARKET ST
VENTURA CA
93003-7783
US

IV. Provider business mailing address

3604 OLDS RD
OXNARD CA
93033-6885
US

V. Phone/Fax

Practice location:
  • Phone: 805-212-4072
  • Fax:
Mailing address:
  • Phone: 805-460-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: