Provider Demographics
NPI:1376809483
Name:DUVA, KYLE RYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RYAN
Last Name:DUVA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3318
Mailing Address - Country:US
Mailing Address - Phone:415-457-2487
Mailing Address - Fax:415-457-5687
Practice Address - Street 1:910 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3318
Practice Address - Country:US
Practice Address - Phone:415-457-2487
Practice Address - Fax:415-457-5687
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012652103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical