Provider Demographics
NPI:1285254623
Name:LONIS, PRESTON KYLE
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:KYLE
Last Name:LONIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21200 KITTRIDGE ST APT 2131
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3043
Mailing Address - Country:US
Mailing Address - Phone:256-665-0559
Mailing Address - Fax:
Practice Address - Street 1:17777 VENTURA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3748
Practice Address - Country:US
Practice Address - Phone:888-209-8874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-144879163W00000X
CA95026134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse