Healthcare Provider Details

I. General information

NPI: 1740126556
Provider Name (Legal Business Name): KIANA E REBUGIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 HERNANDEZ CT
SAN JOSE CA
95148-2215
US

IV. Provider business mailing address

2875 HERNANDEZ CT
SAN JOSE CA
95148-2215
US

V. Phone/Fax

Practice location:
  • Phone: 408-859-1780
  • Fax:
Mailing address:
  • Phone: 408-859-1780
  • 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: