Healthcare Provider Details

I. General information

NPI: 1124988753
Provider Name (Legal Business Name): KALEIDACARE HEALTH AND WELLNESS PHYSICIAN ASSISTANT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 559-417-7575
  • Fax:
Mailing address:
  • Phone: 480-570-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN CROUCH
Title or Position: PRESIDENT
Credential: PA-C
Phone: 559-417-7575