Provider Demographics
NPI:1538469127
Name:GAETANO, KRISTINA MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MORGAN
Last Name:GAETANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LYNN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1432 S DOBSON RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4773
Mailing Address - Country:US
Mailing Address - Phone:480-412-9400
Mailing Address - Fax:480-412-9401
Practice Address - Street 1:1432 S DOBSON RD STE 301
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4773
Practice Address - Country:US
Practice Address - Phone:480-412-9400
Practice Address - Fax:480-412-9401
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4757363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical