Healthcare Provider Details

I. General information

NPI: 1639995343
Provider Name (Legal Business Name): KYERA M HANNAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 E FLORIDA AVE
HEMET CA
92543-4512
US

IV. Provider business mailing address

1105 E FLORIDA AVE
HEMET CA
92543-4512
US

V. Phone/Fax

Practice location:
  • Phone: 951-439-2939
  • Fax: 951-439-2940
Mailing address:
  • Phone: 951-439-2939
  • Fax: 951-439-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: