Provider Demographics
NPI:1316343106
Name:RUNNELS SALDIVAR, KYLA (HIS)
Entity type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:
Last Name:RUNNELS SALDIVAR
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2400
Mailing Address - Country:US
Mailing Address - Phone:225-644-4499
Mailing Address - Fax:225-644-5936
Practice Address - Street 1:1025 N AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2400
Practice Address - Country:US
Practice Address - Phone:225-644-4499
Practice Address - Fax:225-644-5936
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1119237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist