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NPI Code Detail

MEDICARE: KYLIE BREANE MCCORD

MEDICARE: KYLIE BREANE MCCORD
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 Technician

General Provider Information

NPI Number : 1629571021
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLIE BREANE MCCORD
Provider Business Mailing Address
First Line : 1358 BLUE OAKS BLVD STE 300
Second Line :
City : ROSEVILLE
State : CA
Zip : 95678-7040
Country : US
Telephone Number : 916-676-0488
Fax Number :
Provider Business Practice Location Address
First Line : 1358 BLUE OAKS BLVD STE 300
Second Line :
City : ROSEVILLE
State : CA
Zip : 95678-7040
Country : US
Telephone Number : 916-676-0488
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2018
Last Update Date : 03/12/2018

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Directions to “ KYLIE BREANE MCCORD ” Practice Location

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