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NPI Code Detail

MEDICARE: KYLE RACE PEARSON

MEDICARE: KYLE RACE PEARSON
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1801759048
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE RACE PEARSON
Provider Business Mailing Address
First Line : 8831 VENICE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3223
Country : US
Telephone Number : 310-204-5200
Fax Number :
Provider Business Practice Location Address
First Line : 8831 VENICE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3223
Country : US
Telephone Number : 310-204-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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Directions to “ KYLE RACE PEARSON ” Practice Location

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