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General NPI Number Information
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NPI Number | 1619164985
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Entity Type | Individual
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Provider Name | KYLA BARAJAS REDWOOD PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 1450 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511
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Country | US
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Telephone | 203-789-4135
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 CORNERSTONE CT
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City | CHESHIRE
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State | CT
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Zip | 06410-1860
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Country | US
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Telephone | 207-576-2900
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001976
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01451
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1976
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License Number State | CT
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