Provider Demographics
NPI:1649241837
Name:KASEL, SHAYLA FOWLER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:FOWLER
Last Name:KASEL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1070 COUNTRY CLUB DR. WEST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:805-306-0222
Mailing Address - Fax:805-583-2048
Practice Address - Street 1:1070 COUNTRY CLUB DR. WEST
Practice Address - Street 2:SUITE C
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-306-0222
Practice Address - Fax:805-583-2048
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAG78249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK6188759OtherDEA NUMBER
CAH13682Medicare UPIN
CABK6188759OtherDEA NUMBER