Provider Demographics
NPI:1225319015
Name:NICOLETTI, KAITLIN J (DO)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:J
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 J ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3666
Mailing Address - Country:US
Mailing Address - Phone:916-733-6990
Mailing Address - Fax:916-733-6985
Practice Address - Street 1:3939 J STREET SUITE 310
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-733-6990
Practice Address - Fax:916-733-6985
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14567207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology