Provider Demographics
NPI:1891544250
Name:BACARRO, KALEYA
Entity type:Individual
Prefix:
First Name:KALEYA
Middle Name:
Last Name:BACARRO
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 1:269 S BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-4307
Mailing Address - Country:US
Mailing Address - Phone:559-361-2696
Mailing Address - Fax:
Practice Address - Street 1:13944 S ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-9207
Practice Address - Country:US
Practice Address - Phone:559-556-0030
Practice Address - Fax:559-556-0030
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty