Provider Demographics
NPI:1407899180
Name:GRAZIANO, KRISTIN L (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:GRAZIANO
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:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-0290
Mailing Address - Country:US
Mailing Address - Phone:575-586-0315
Mailing Address - Fax:
Practice Address - Street 1:2573 NM-522
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556-0290
Practice Address - Country:US
Practice Address - Phone:575-586-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6664207Q00000X
NMA-2341-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ721284Medicaid
AZ721284Medicaid