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NPI Code Detail

MEDICARE: KAYLA TISON

MEDICARE: KAYLA TISON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerCA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1821943416
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA TISON
Provider Business Mailing Address
First Line : 800 N STATE COLLEGE BLVD
Second Line :
City : FULLERTON
State : CA
Zip : 92831-3547
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3002 W CENTENNIAL RD
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-3904
Country : US
Telephone Number : 714-433-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2026
Last Update Date : 02/28/2026

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Directions to “ KAYLA TISON ” Practice Location

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