Provider Demographics
NPI:1578627642
Name:BENNETT, KRISTIN (DO)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:PATIENT SUPPORT SERVICES BUILDING SUITE 1200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-5031
Mailing Address - Fax:916-734-7980
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PATIENT SUPPORT SERVICES BUILDING SUITE 1200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5031
Practice Address - Fax:916-734-7980
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology