Provider Demographics
NPI:1073290227
Name:DEL ROSARIO, MYKAILA KANG
Entity Type:Individual
Prefix:
First Name:MYKAILA
Middle Name:KANG
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 BAKER LN STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5454
Mailing Address - Country:US
Mailing Address - Phone:775-996-3890
Mailing Address - Fax:
Practice Address - Street 1:3785 BAKER LN STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5454
Practice Address - Country:US
Practice Address - Phone:775-996-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician