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Individual
KYLA MAESTAS
Active
Individual
KYLA MAESTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130030000
MEDICAID 9 DIGIT NPI
WY
Enumeration date
03/30/2016
Last updated
07/05/2016
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