Healthcare Provider Details

I. General information

NPI: 1588223663
Provider Name (Legal Business Name): KAIRA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 RIO SAN DIEGO DR STE 340
SAN DIEGO CA
92108-1669
US

IV. Provider business mailing address

8885 RIO SAN DIEGO DR STE 340
SAN DIEGO CA
92108-1669
US

V. Phone/Fax

Practice location:
  • Phone: 619-795-9925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13442
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: