Individual
KAYLA SIBBALUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
201 FAIR ST, PETALUMA, CA 94952-2516
(707) 778-4651
Mailing address
652 POWDERHORN AVE, SANTA ROSA, CA 95407-2743
(707) 536-7888
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2000025463
CA
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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