Provider Demographics
NPI:1467090605
Name:CHAVIRA, KYRA BELLA (RBT)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:BELLA
Last Name:CHAVIRA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SHADOWRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7301
Mailing Address - Country:US
Mailing Address - Phone:408-677-1229
Mailing Address - Fax:
Practice Address - Street 1:113 N MARINE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6508
Practice Address - Country:US
Practice Address - Phone:408-677-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician