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Individual

MR. KYLE MATTHEW LUIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPT

Contact information

Practice address
40 EAST MINARETS, PINEDALE, CA 93650
(559) 436-4650
Mailing address
40 EAST MINARETS, PINEDALE, CA 93650
(559) 436-0482

Taxonomy

Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36277
CA

Other

Enumeration date
08/09/2012
Last updated
08/17/2012
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