Healthcare Provider Details

I. General information

NPI: 1891537981
Provider Name (Legal Business Name): KAYLAH P-M RENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4052 E AVENUE S4
PALMDALE CA
93552-5101
US

IV. Provider business mailing address

4052 E AVENUE S4
PALMDALE CA
93552-5101
US

V. Phone/Fax

Practice location:
  • Phone: 661-492-2198
  • Fax:
Mailing address:
  • Phone: 661-492-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6181025
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: