Healthcare Provider Details

I. General information

NPI: 1083498810
Provider Name (Legal Business Name): KYARA VICKERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 MURPHY CANYON RD STE 320325
SAN DIEGO CA
92123-4446
US

IV. Provider business mailing address

3870 MURPHY CANYON RD STE 320325
SAN DIEGO CA
92123-4446
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-0460
  • Fax:
Mailing address:
  • Phone: 858-300-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: