Individual
KYLE ADDISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6630 MARYMONTE CT, SAN JOSE, CA 95120-4517
(408) 205-8996
Mailing address
1058 S 5TH ST, APT. #201, SAN JOSE, CA 95112-6702
(510) 673-2285
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
3649
CA
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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