Provider Demographics
NPI:1467165035
Name:BELL, KAITLYN ROSE
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:ROSE
Last Name:BELL
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 1:2215 WAGON TRAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-9247
Mailing Address - Country:US
Mailing Address - Phone:951-520-7449
Mailing Address - Fax:
Practice Address - Street 1:2215 WAGON TRAIN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-9247
Practice Address - Country:US
Practice Address - Phone:951-520-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician