Provider Demographics
NPI:1992987259
Name:REBIERO, KRISTINE ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANN
Last Name:REBIERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6133
Mailing Address - Country:US
Mailing Address - Phone:209-558-7698
Mailing Address - Fax:
Practice Address - Street 1:1030 SCENIC DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6133
Practice Address - Country:US
Practice Address - Phone:209-558-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17922363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17922Medicaid
CA1992987259Medicaid
CAAW428XMedicare PIN
CA1992987259Medicaid