Provider Demographics
NPI:1952190969
Name:RAYAS ARCHUNDIA, KAMILLA
Entity type:Individual
Prefix:
First Name:KAMILLA
Middle Name:
Last Name:RAYAS ARCHUNDIA
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 1:4469 N BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2201
Mailing Address - Country:US
Mailing Address - Phone:951-472-8077
Mailing Address - Fax:
Practice Address - Street 1:4469 N BROADMOOR AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-2201
Practice Address - Country:US
Practice Address - Phone:951-472-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-01009543246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy