Provider Demographics
NPI:1891372884
Name:HERNANDEZ, KYLA RAE (MED BCBA)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:RAE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4589 S LORA LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-0053
Mailing Address - Country:US
Mailing Address - Phone:928-750-0623
Mailing Address - Fax:
Practice Address - Street 1:206 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2245
Practice Address - Country:US
Practice Address - Phone:928-750-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2023-08-09
Deactivation Date:2023-01-12
Deactivation Code:
Reactivation Date:2023-03-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty