Provider Demographics
NPI:1639207608
Name:SCAVULLI, KAY BOWMAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:BOWMAN
Last Name:SCAVULLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 AVENIDA ALAMAR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3313
Mailing Address - Country:US
Mailing Address - Phone:858-454-5361
Mailing Address - Fax:858-490-4405
Practice Address - Street 1:2440 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4858
Practice Address - Country:US
Practice Address - Phone:858-490-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215702163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse