Healthcare Provider Details

I. General information

NPI: 1710892591
Provider Name (Legal Business Name): KYLE ANGELO CRUZ SIY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 PEABODY RD STE 300
VACAVILLE CA
95687-6695
US

IV. Provider business mailing address

2050 PEABODY RD STE 300
VACAVILLE CA
95687-6695
US

V. Phone/Fax

Practice location:
  • Phone: 707-446-8600
  • Fax: 707-446-8100
Mailing address:
  • Phone: 707-446-8600
  • Fax: 707-446-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23491
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: