Healthcare Provider Details

I. General information

NPI: 1053242487
Provider Name (Legal Business Name): MIKAYLA AAHLIYAH LOAIZA NA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 GRAND CANAL BLVD STE 2
STOCKTON CA
95207-8107
US

IV. Provider business mailing address

430 PENGUIN CT
PATTERSON CA
95363-9019
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax: 888-880-9270
Mailing address:
  • Phone: 209-252-2515
  • Fax: 209-252-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberNA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: