MEDICARE: KYLINE SKY BELLOTTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1134787815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLINE SKY BELLOTTI

Provider Business Mailing Address
First Line	:	5025 COLLWOOD BLVD # 3316
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-2126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 COLLWOOD BLVD # 3316
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-2126
Country	:	US
Telephone Number	:	707-799-6048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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