Provider Demographics
NPI:1174352660
Name:CONNER, KAITLYN RAYANN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RAYANN
Last Name:CONNER
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 1:12718 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8847
Mailing Address - Country:US
Mailing Address - Phone:951-502-4413
Mailing Address - Fax:
Practice Address - Street 1:12718 BRIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8847
Practice Address - Country:US
Practice Address - Phone:951-502-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information