Provider Demographics
NPI:1790495000
Name:BACIERTO, CRISTOPHER (NP)
Entity Type:Individual
Prefix:
First Name:CRISTOPHER
Middle Name:
Last Name:BACIERTO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 DRAGOO PARK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1845
Mailing Address - Country:US
Mailing Address - Phone:209-602-4212
Mailing Address - Fax:
Practice Address - Street 1:3509 COFFEE RD STE D3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1357
Practice Address - Country:US
Practice Address - Phone:844-227-7599
Practice Address - Fax:855-903-5155
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily