Healthcare Provider Details

I. General information

NPI: 1871400960
Provider Name (Legal Business Name): KYLE JOHN MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 YGNACIO VALLEY RD STE 100
WALNUT CREEK CA
94596-3897
US

IV. Provider business mailing address

2176 MORNINGTON LN
SAN RAMON CA
94582-5777
US

V. Phone/Fax

Practice location:
  • Phone: 925-208-9091
  • Fax:
Mailing address:
  • Phone: 925-208-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: