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NPI Code Detail

MEDICARE: KYLA JEANNE HENDRICKS PA

MEDICARE: KYLA JEANNE HENDRICKS PA
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
1363A00000XPhysician AssistantPA16030CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA16030OTHERCAPA STATE LICENSE

General Provider Information

NPI Number : 1962587717
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLA JEANNE HENDRICKS PA
Provider Business Mailing Address
First Line : 1203 FLYNN RD UNIT 160
Second Line :
City : CAMARILLO
State : CA
Zip : 93012-6203
Country : US
Telephone Number : 805-804-4168
Fax Number : 805-830-1177
Provider Business Practice Location Address
First Line : 2525 ERRINGER RD
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-2352
Country : US
Telephone Number : 805-527-1404
Fax Number : 805-527-5246
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/14/2025

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Directions to “ KYLA JEANNE HENDRICKS PA” Practice Location

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