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General NPI Number Information
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NPI Number | 1740309608
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Entity Type | Individual
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Provider Name | M. BARBARA KLYDE PAC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 1711 W KATELLA AVE
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City | ANAHEIM
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State | CA
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Zip | 92804-6450
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Country | US
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Telephone | 714-400-2959
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Fax |
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Provider Business Mailing Address
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Address Line | 2391 N RIVER TRAIL RD
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City | ORANGE
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State | CA
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Zip | 92865-2036
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Country | US
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Telephone | 171-492-1896
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Fax | 171-463-7426
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 10707
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License Number State | CA
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