Provider Demographics
NPI:1568124097
Name:KYLES, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KYLES
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 1:760 MILITARY E
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3563
Mailing Address - Country:US
Mailing Address - Phone:707-741-0634
Mailing Address - Fax:
Practice Address - Street 1:760 MILITARY E
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3563
Practice Address - Country:US
Practice Address - Phone:707-741-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist