Provider Demographics
NPI:1740309608
Name:KLYDE, M. BARBARA (PAC)
Entity type:Individual
Prefix:MS
First Name:M.
Middle Name:BARBARA
Last Name:KLYDE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 N RIVER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2036
Mailing Address - Country:US
Mailing Address - Phone:171-492-1896
Mailing Address - Fax:171-463-7426
Practice Address - Street 1:1711 W KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6450
Practice Address - Country:US
Practice Address - Phone:714-400-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 10707363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical