Healthcare Provider Details

I. General information

NPI: 1700506839
Provider Name (Legal Business Name): KACEY FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E ST. CHARLES ST
SAN ANDREAS CA
95249-9713
US

IV. Provider business mailing address

891 MOUNTAIN RANCH RD BLDG L
SAN ANDREAS CA
95249-9713
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: