Provider Demographics
NPI:1306691498
Name:NEWLIN, MIKAYLA JENAE
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:JENAE
Last Name:NEWLIN
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 1:29861 CABO DEL OESTE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5968
Mailing Address - Country:US
Mailing Address - Phone:909-855-5026
Mailing Address - Fax:
Practice Address - Street 1:29861 CABO DEL OESTE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5968
Practice Address - Country:US
Practice Address - Phone:909-855-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician