Provider Demographics
NPI:1295191476
Name:KENYON, PAULA RIBEIRO BRAGA (PHD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:RIBEIRO BRAGA
Last Name:KENYON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 NUFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8569
Mailing Address - Country:US
Mailing Address - Phone:508-335-9083
Mailing Address - Fax:
Practice Address - Street 1:6339 NUFFIELD CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8569
Practice Address - Country:US
Practice Address - Phone:508-335-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-01-0600103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst