Provider Demographics
NPI:1235659079
Name:WILSON, KAYLA MARINA (MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARINA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6556 ARLINGTON AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1909
Mailing Address - Country:US
Mailing Address - Phone:951-232-8365
Mailing Address - Fax:
Practice Address - Street 1:6556 ARLINGTON AVE APT 2C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1909
Practice Address - Country:US
Practice Address - Phone:951-232-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer