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General NPI Number Information
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NPI Number | 1588534432
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Entity Type | Individual
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Provider Name | MR. JARRED KYLE M STA ANA
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Gender | Male
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 2780 SKYPARK DR STE 410
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City | TORRANCE
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State | CA
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Zip | 90505-7519
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Country | US
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Telephone | 833-223-8326
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Fax |
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Provider Business Mailing Address
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Address Line | 2780 SKYPARK DR STE 410
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City | TORRANCE
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State | CA
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Zip | 90505-7519
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Country | US
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Telephone | 833-223-8326
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5894
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 987456A
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 1234
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License Number State | CA
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