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General NPI Number Information
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NPI Number | 1467067033
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Entity Type | Individual
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Provider Name | KYLIE LEI PATRICK
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 802 MAGNOLIA AVE
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City | CORONA
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State | CA
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Zip | 92879-3104
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Country | US
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Telephone | 951-686-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 21600 OXNARD ST STE 1800
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-7807
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Country | US
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Telephone | 818-345-2345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | F7008613
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License Number State | CA
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