Provider Demographics
NPI:1487098968
Name:SHIPLEY, KAYLA ORTEGO
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ORTEGO
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE KARAM
Other - Last Name:ORTEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 RIO ROBLES E
Mailing Address - Street 2:#218
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1631
Mailing Address - Country:US
Mailing Address - Phone:337-654-6053
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:ALWAY BLDG., ROOM M121
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-725-9445
Practice Address - Fax:650-723-0121
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA303372207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program