Provider Demographics
NPI:1942066790
Name:ROCK, KAYLA GABRIELLE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:GABRIELLE
Last Name:ROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24015 COPPER HILL DR APT 4301
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-5005
Mailing Address - Country:US
Mailing Address - Phone:661-627-6108
Mailing Address - Fax:
Practice Address - Street 1:520 W PALMDALE BLVD STE H
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4230
Practice Address - Country:US
Practice Address - Phone:661-575-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program