Healthcare Provider Details

I. General information

NPI: 1619790888
Provider Name (Legal Business Name): KIRA EMILY STRAUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

IV. Provider business mailing address

2420 MERLE AVE
MODESTO CA
95355-8801
US

V. Phone/Fax

Practice location:
  • Phone: 209-900-3722
  • Fax:
Mailing address:
  • Phone: 209-204-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: