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General NPI Number Information
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NPI Number | 1679125298
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Entity Type | Individual
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Provider Name | KAYLA JEAN WEBER NP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2019
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Last Update Date | 07/13/2019
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Provider Practice Location Address
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Address Line | 1565 ADAMS AVE STE 12
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City | COSTA MESA
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State | CA
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Zip | 92626-3814
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Country | US
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Telephone | 949-614-0052
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Fax |
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Provider Business Mailing Address
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Address Line | 9111 MEDITERRANEAN DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-4638
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Country | US
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Telephone | 949-233-0485
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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 | 95012184
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License Number State | CA
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