Provider Demographics
NPI:1083170575
Name:REGISTER-LUITZE, KYLEE
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:REGISTER-LUITZE
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 1:25701 N TULLY RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9738
Mailing Address - Country:US
Mailing Address - Phone:916-544-7651
Mailing Address - Fax:
Practice Address - Street 1:25701 N TULLY RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9738
Practice Address - Country:US
Practice Address - Phone:916-544-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician