MEDICARE: KAYLA DRIGO

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1790275238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA DRIGO

Provider Business Mailing Address
First Line	:	7343 VILLAGE LAKE DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-3206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13411 BRIAR FOREST DR APT 4043
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2666
Country	:	US
Telephone Number	:	832-602-7588
Fax Number	:

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

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	12/14/2018

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Directions to “ KAYLA DRIGO ” Practice Location

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