Kyrllos Atef Rezekalla, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3221 Carter Ave
Marina del Rey, CA 90292-4944

Phone

(310) 430-9795

NPI assigned

Jan 12, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Golden State Emergency Physicians Inc

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1770886558
  Medicare reassignment
• Ridgeline Emergency Physicians Medical Group, Inc.

  • Emergency Medicine Physician
  • Northridge, CA
  • NPI 1972953230
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693094400000",
    "number": "1093304388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 CARTER AVE UNIT 317",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902924960",
            "telephone_number": "310-430-9795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 CARTER AVE",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902924944",
            "telephone_number": "310-430-9795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZEKALLA",
        "first_name": "KYRLLOS",
        "middle_name": "ATEF",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-12",
        "last_updated": "2023-08-27",
        "certification_date": "2023-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Remedy Pain Solutions, Inc. (Remedy Surgical Center)
• Remedy Pain Solutions, Inc.
• Revolve Recovery, Inc
• Adrian T. Reyes, M.D.
• Starlesha Reynolds
• Beronie Vondell Richardson, MD
• Jana Richey, DPT
• Nancy McLaughlin Richmond, PMHNP-BC
• Hilda Riderer, D.O.
• Domenico Rinaldi, OD

• Physician Assistant in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.