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General NPI Number Information
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NPI Number | 1174218895
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Entity Type | Individual
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Provider Name | KYRA GRACE MCNATT
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 3737 MORAGA AVE STE A204
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City | SAN DIEGO
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State | CA
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Zip | 92117-5489
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Country | US
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Telephone | 858-352-6015
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 E WASHINGTON AVE APT 6
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City | EL CAJON
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State | CA
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Zip | 92019-2556
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Country | US
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Telephone | 619-938-5808
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | L9707
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License Number State | CA
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