Healthcare Provider Details

I. General information

NPI: 1669963757
Provider Name (Legal Business Name): KAYLA MARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 PIRRONE RD
SALIDA CA
95368-9313
US

IV. Provider business mailing address

5716 PIRRONE RD
SALIDA CA
95368-9313
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-7466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-24537
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number20-42314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: