Provider Demographics
NPI:1215973276
Name:AMENDOLA, KRISTA MARIE (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:AMENDOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:525 SPRUCE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2682
Mailing Address - Country:US
Mailing Address - Phone:415-668-8900
Mailing Address - Fax:415-668-1695
Practice Address - Street 1:525 SPRUCE ST STE 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2682
Practice Address - Country:US
Practice Address - Phone:415-668-8900
Practice Address - Fax:415-668-1695
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG082076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G06456Medicare UPIN