Provider Demographics
NPI:1093304388
Name:REZEKALLA, KYRLLOS ATEF (PA-C)
Entity Type:Individual
Prefix:
First Name:KYRLLOS
Middle Name:ATEF
Last Name:REZEKALLA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3221 CARTER AVE UNIT 317
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4960
Mailing Address - Country:US
Mailing Address - Phone:310-430-9795
Mailing Address - Fax:
Practice Address - Street 1:3221 CARTER AVE
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-4944
Practice Address - Country:US
Practice Address - Phone:310-430-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2023-08-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant