MEDICARE: KAYLA IVANNA DERIOT

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	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker		CA

General Provider Information

NPI Number	:	1578037867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA IVANNA DERIOT

Provider Business Mailing Address
First Line	:	73255 EL PASEO STE 18
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4249
Country	:	US
Telephone Number	:	760-385-3959
Fax Number	:

Provider Business Practice Location Address
First Line	:	73255 EL PASEO STE 18
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4249
Country	:	US
Telephone Number	:	760-385-3959
Fax Number	:

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

Provider Enumeration Date	:	01/19/2019
Last Update Date	:	01/16/2026

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