Provider Demographics
NPI:1528749702
Name:CARLUCCI, KAYLA MICHELE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MICHELE
Last Name:CARLUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18419 US HIGHWAY 18 STE 6
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2333
Mailing Address - Country:US
Mailing Address - Phone:760-946-9955
Mailing Address - Fax:
Practice Address - Street 1:18419 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2333
Practice Address - Country:US
Practice Address - Phone:760-946-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner