Provider Demographics
NPI:1275378010
Name:PIETRO, KRISTEN HANNA (DR)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HANNA
Last Name:PIETRO
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 BUSCH DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3805
Mailing Address - Country:US
Mailing Address - Phone:310-924-5842
Mailing Address - Fax:
Practice Address - Street 1:5763 BUSCH DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3805
Practice Address - Country:US
Practice Address - Phone:310-924-5842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist