Provider Demographics
NPI:1861166415
Name:DELA CUESTA, KYLE ANTHONY (BSN, RN)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANTHONY
Last Name:DELA CUESTA
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3536
Mailing Address - Country:US
Mailing Address - Phone:805-428-0872
Mailing Address - Fax:
Practice Address - Street 1:1812 VERDUGO BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1407
Practice Address - Country:US
Practice Address - Phone:818-952-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95166664163WG0600X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty