MEDICARE: SURAYA JEAN CAREE KNOTT

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	106S00000X	Behavior Technician	Y9370970	CA

General Provider Information

NPI Number	:	1912854787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURAYA JEAN CAREE KNOTT

Provider Business Mailing Address
First Line	:	220 BRETT PL
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-5301
Country	:	US
Telephone Number	:	760-576-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 BRETT PL
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-5301
Country	:	US
Telephone Number	:	760-576-6056
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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