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General NPI Number Information
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NPI Number | 1003612060
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Entity Type | Individual
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Provider Name | KAYLA BROOKE MENJIVAR NP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1418 E MAIN ST STE 210
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City | SANTA MARIA
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State | CA
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Zip | 93454-4836
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Country | US
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Telephone | 805-928-3678
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Fax |
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Provider Business Mailing Address
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Address Line | 3922 CLUB HOUSE CT
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City | LOMPOC
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State | CA
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Zip | 93436-1368
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95031486
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License Number State | CA
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