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General NPI Number Information
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NPI Number | 1114157567
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Entity Type | Individual
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Provider Name | KESJANA CAKE PSYD, MA
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 09/01/2024
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Provider Practice Location Address
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Address Line | 5005 CANYON CREST DR
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City | RIVERSIDE
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State | CA
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Zip | 92507-7721
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Country | US
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Telephone | 747-224-2090
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Fax | 747-444-4969
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Provider Business Mailing Address
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Address Line | 975 FLYNN RD
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City | CAMARILLO
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State | CA
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Zip | 93012-8704
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Country | US
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Telephone | 805-388-7740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 126135
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 29835
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License Number State | CA
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