Provider Demographics
NPI:1548826290
Name:GOMEZ, KAYLA ANN (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W SPRINGER AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-7601
Mailing Address - Country:US
Mailing Address - Phone:954-682-1889
Mailing Address - Fax:
Practice Address - Street 1:275 SE CABOT DR STE B101
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3740
Practice Address - Country:US
Practice Address - Phone:360-675-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65356363A00000X
WAPA61201703363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant