Provider Demographics
NPI:1174218895
Name:MCNATT, KYRA GRACE
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:GRACE
Last Name:MCNATT
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 1:1533 E WASHINGTON AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2556
Mailing Address - Country:US
Mailing Address - Phone:619-938-5808
Mailing Address - Fax:
Practice Address - Street 1:3737 MORAGA AVE STE A204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5489
Practice Address - Country:US
Practice Address - Phone:858-352-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist