Provider Demographics
NPI:1275842536
Name:KHILLA, AYAD IBRAHIM (FNP-C)
Entity Type:Individual
Prefix:
First Name:AYAD
Middle Name:IBRAHIM
Last Name:KHILLA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 CALLE INDEPENDENCIA
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3709
Mailing Address - Country:US
Mailing Address - Phone:714-350-3420
Mailing Address - Fax:714-369-2017
Practice Address - Street 1:122 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3601
Practice Address - Country:US
Practice Address - Phone:213-749-6500
Practice Address - Fax:213-741-0285
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily