Provider Demographics
NPI:1265921068
Name:GARCIA, KAYLIE ANN
Entity type:Individual
Prefix:MS
First Name:KAYLIE
Middle Name:ANN
Last Name:GARCIA
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 1:12660 SANDBURG WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5833
Mailing Address - Country:US
Mailing Address - Phone:909-831-9027
Mailing Address - Fax:
Practice Address - Street 1:12660 SANDBURG WAY
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5833
Practice Address - Country:US
Practice Address - Phone:909-831-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician