Healthcare Provider Details

I. General information

NPI: 1417793506
Provider Name (Legal Business Name): KAYLA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 LENNON LN STE 100
WALNUT CREEK CA
94598-2460
US

IV. Provider business mailing address

1208 ESTON ST
CAMARILLO CA
93010-4814
US

V. Phone/Fax

Practice location:
  • Phone: 925-465-1585
  • Fax: 925-433-6555
Mailing address:
  • Phone: 805-765-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: