Healthcare Provider Details

I. General information

NPI: 1467383364
Provider Name (Legal Business Name): KAYLEE VANDER ZWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 PEDLEY RD
JURUPA VALLEY CA
92509-3966
US

IV. Provider business mailing address

4850 PEDLEY RD
JURUPA VALLEY CA
92509-3966
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: