Healthcare Provider Details

I. General information

NPI: 1487466363
Provider Name (Legal Business Name): CHEYENNE MONIQUE LASALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CARR ST
WATSONVILLE CA
95076-4710
US

IV. Provider business mailing address

300 HARVEY WEST BLVD
SANTA CRUZ CA
95060-2103
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-8132
  • Fax:
Mailing address:
  • Phone: 831-425-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: