Provider Demographics
NPI:1598091712
Name:FOLEY, KIERA MARIKO
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:MARIKO
Last Name:FOLEY
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 1:1619 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7601
Mailing Address - Country:US
Mailing Address - Phone:805-614-9535
Mailing Address - Fax:805-614-9390
Practice Address - Street 1:1619 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7601
Practice Address - Country:US
Practice Address - Phone:805-614-9535
Practice Address - Fax:805-614-9390
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000009153OtherUPIN