Healthcare Provider Details

I. General information

NPI: 1831036573
Provider Name (Legal Business Name): KAYLA ANN ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2672 BAYSHORE PKWY STE 1045
MOUNTAIN VIEW CA
94043-1015
US

IV. Provider business mailing address

1850 11TH ST
ARCATA CA
95521-5406
US

V. Phone/Fax

Practice location:
  • Phone: 650-862-7320
  • Fax:
Mailing address:
  • Phone: 207-279-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number94029594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: