Basic Information
| Provider Information | |||||||||
| NPI: | 1144840612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PELZ-WALSH | ||||||||
| FirstName: | KYRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 E COTA ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931011624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177850 | ||||||||
| FaxNumber: | 8059638880 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 EMBARCADERO DEL MAR | ||||||||
| Address2: | |||||||||
| City: | ISLA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931174869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059681511 | ||||||||
| FaxNumber: | 8059687041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2020 | ||||||||
| LastUpdateDate: | 04/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 95159571 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 95159571 | 01 | CA | NURSE PRACTITIONER LICENSE | OTHER |