Provider Demographics
NPI:1487143640
Name:ALBRIGHT, KRISTEN PROFETA
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:PROFETA
Last Name:ALBRIGHT
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 1:581 MCCRAY ST STE F
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4091
Mailing Address - Country:US
Mailing Address - Phone:440-856-6180
Mailing Address - Fax:
Practice Address - Street 1:581 MCCRAY ST STE F
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-4091
Practice Address - Country:US
Practice Address - Phone:831-636-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
CAE5757213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty