Healthcare Provider Details

I. General information

NPI: 1932621513
Provider Name (Legal Business Name): MS. KAILA ROSE HATTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/21/2022
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 MURRAY AVE STE 100
GILROY CA
95020-3617
US

IV. Provider business mailing address

501 SOQUEL AVE STE I
SANTA CRUZ CA
95062-2386
US

V. Phone/Fax

Practice location:
  • Phone: 408-665-4908
  • Fax: 408-842-0383
Mailing address:
  • Phone: 831-332-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: