Provider Demographics
NPI:1154955078
Name:MOWATT, KAYLA CRISTINA (DO)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:CRISTINA
Last Name:MOWATT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KAYLA
Other - Middle Name:CRISTINA
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:574 N KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93523-2735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 N WOLFE AVE BLDG 3925
Practice Address - Street 2:
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-6201
Practice Address - Country:US
Practice Address - Phone:661-275-2661
Practice Address - Fax:661-277-6736
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine