Provider Demographics
NPI:1477435063
Name:CANIZALES, KYOKO (PHD)
Entity type:Individual
Prefix:DR
First Name:KYOKO
Middle Name:
Last Name:CANIZALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KYOKO
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4505 RAMONA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3262
Mailing Address - Country:US
Mailing Address - Phone:626-590-5750
Mailing Address - Fax:
Practice Address - Street 1:4505 RAMONA AVE APT 6
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3262
Practice Address - Country:US
Practice Address - Phone:626-590-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist