Provider Demographics
NPI:1013646306
Name:KILEKAS, MIA'ARIARNA (PA-C, MSPA)
Entity Type:Individual
Prefix:
First Name:MIA'ARIARNA
Middle Name:
Last Name:KILEKAS
Suffix:
Gender:F
Credentials:PA-C, MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2298 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4867
Mailing Address - Country:US
Mailing Address - Phone:714-788-1153
Mailing Address - Fax:
Practice Address - Street 1:2298 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4867
Practice Address - Country:US
Practice Address - Phone:714-788-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA61323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant