Provider Demographics
NPI:1417713983
Name:MUTHAIYA, AHILA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AHILA
Middle Name:
Last Name:MUTHAIYA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 MAPLELEAF TER
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6129
Mailing Address - Country:US
Mailing Address - Phone:818-679-5381
Mailing Address - Fax:
Practice Address - Street 1:166 GEARY ST STE 1500
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5628
Practice Address - Country:US
Practice Address - Phone:415-636-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029110363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health