Basic Information
| Provider Information | |||||||||
| NPI: | 1366110017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANISKIS | ||||||||
| FirstName: | KYLA | ||||||||
| MiddleName: | SKYE | ||||||||
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| Credential: | RADT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24016 ELROND LN | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926303649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6573659854 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20331 FLANAGAN ROAD | ||||||||
| Address2: | |||||||||
| City: | TRABUCO CANYON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185828832 | ||||||||
| FaxNumber: | 8185828836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2021 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | R1431300521 | CA | Y | Nursing Service Related Providers | Technician |
No ID Information.