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Individual

KYLE THOMAS ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
L.P,T

Contact information

Practice address
2115 7TH AVE, SANTA CRUZ, CA 95062-1663
(831) 420-0120
Mailing address
2115 7TH AVE, SANTA CRUZ, CA 95062-1663
(831) 420-0120

Taxonomy

Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 35914
CA

Other

Enumeration date
01/07/2013
Last updated
01/07/2013
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