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NPI Code Detail

MEDICARE: MIKAYLA LYNN EHLENBERGER

MEDICARE: MIKAYLA LYNN EHLENBERGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB602459CA

General Provider Information

NPI Number : 1215561428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAYLA LYNN EHLENBERGER
Provider Business Mailing Address
First Line : 303 MARTI WAY
Second Line :
City : SAN JOSE
State : CA
Zip : 95136-2136
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 577 SALMAR AVE
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1453
Country : US
Telephone Number : 408-872-2551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2020
Last Update Date : 08/05/2024

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Directions to “ MIKAYLA LYNN EHLENBERGER ” Practice Location

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