Provider Demographics
NPI:1063067064
Name:PARIS, KIANA ISELA
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:ISELA
Last Name:PARIS
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 1:10875 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-4037
Mailing Address - Country:US
Mailing Address - Phone:951-488-4919
Mailing Address - Fax:
Practice Address - Street 1:10875 FENTON RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-4037
Practice Address - Country:US
Practice Address - Phone:951-488-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician