Provider Demographics
NPI:1770773962
Name:ZAYLOR, KELLIE JO (DO)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:JO
Last Name:ZAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:JO
Other - Last Name:LIMBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:11333 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1116
Practice Address - Country:US
Practice Address - Phone:216-896-1800
Practice Address - Fax:216-896-1801
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009181207Q00000X
CA20A13299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine