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NPI Code Detail

MEDICARE: KAITLYN BEALL

MEDICARE: KAITLYN BEALL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1477488112
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN BEALL
Provider Business Mailing Address
First Line : 2820 CAMINO DEL RIO S STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3822
Country : US
Telephone Number : 858-264-5858
Fax Number : 858-264-5858
Provider Business Practice Location Address
First Line : 2820 CAMINO DEL RIO S STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3822
Country : US
Telephone Number : 858-264-5858
Fax Number : 858-264-5858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/15/2026

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Directions to “ KAITLYN BEALL ” Practice Location

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