Provider Demographics
NPI:1528943628
Name:CHERRY, KAYLA KRISTINE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:KRISTINE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10293 BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2264
Mailing Address - Country:US
Mailing Address - Phone:714-816-3300
Mailing Address - Fax:
Practice Address - Street 1:10293 BLOOMFIELD ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2264
Practice Address - Country:US
Practice Address - Phone:714-816-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPPS-220149053103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool