Healthcare Provider Details

I. General information

NPI: 1790041622
Provider Name (Legal Business Name): KEVIN L GAST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BAYONET CIR SHELTER COVE
MARINA CA
93933-4600
US

IV. Provider business mailing address

412 DELA VINA AVE APT 30
MONTEREY CA
93940-3962
US

V. Phone/Fax

Practice location:
  • Phone: 831-384-7251
  • Fax:
Mailing address:
  • Phone: 660-562-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: