MEDICARE: KYIAH CYRAI GATTISON

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
1	106S00000X	Behavior Technician	Y9309683	CA

General Provider Information

NPI Number	:	1679426415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYIAH CYRAI GATTISON

Provider Business Mailing Address
First Line	:	436 W SAMPLE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1419
Country	:	US
Telephone Number	:	559-244-9078
Fax Number	:

Provider Business Practice Location Address
First Line	:	436 W SAMPLE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1419
Country	:	US
Telephone Number	:	559-244-9078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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Directions to “ KYIAH CYRAI GATTISON ” Practice Location

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