Provider Demographics
NPI:1265132526
Name:URIBE, KEN-YA A
Entity type:Individual
Prefix:
First Name:KEN-YA
Middle Name:A
Last Name:URIBE
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 1:640 E 3RD ST SPC 10
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1522
Mailing Address - Country:US
Mailing Address - Phone:442-250-2224
Mailing Address - Fax:
Practice Address - Street 1:640 E 3RD ST SPC 10
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250-1522
Practice Address - Country:US
Practice Address - Phone:442-250-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst