Healthcare Provider Details

I. General information

NPI: 1164208740
Provider Name (Legal Business Name): KAITLIN NICHOLE PERRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3040
US

IV. Provider business mailing address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3040
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax: 619-330-2760
Mailing address:
  • Phone: 619-383-6868
  • Fax: 619-330-2760

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number18137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: