Provider Demographics
NPI:1528611571
Name:PATLAN, KIANA ALEXA
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:ALEXA
Last Name:PATLAN
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 1:3158 CABERNET DR
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2820
Mailing Address - Country:US
Mailing Address - Phone:951-531-6574
Mailing Address - Fax:
Practice Address - Street 1:4327 W CETON DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7702
Practice Address - Country:US
Practice Address - Phone:602-635-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant