Provider Demographics
NPI:1225400922
Name:PASCUAL, KAYLA (PTA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W LINCOLN AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3734
Mailing Address - Country:US
Mailing Address - Phone:928-446-6812
Mailing Address - Fax:
Practice Address - Street 1:404 W LINCOLN AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3734
Practice Address - Country:US
Practice Address - Phone:928-446-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA972314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility