Healthcare Provider Details

I. General information

NPI: 1073346250
Provider Name (Legal Business Name): KYLA SEQUOIA CRONN-HETRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E BEACH ST
WATSONVILLE CA
95076-4752
US

IV. Provider business mailing address

259 MAPLE ST
SALINAS CA
93901-4148
US

V. Phone/Fax

Practice location:
  • Phone: 831-226-3909
  • Fax: 831-319-4468
Mailing address:
  • Phone: 831-585-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: