Provider Demographics
NPI:1891075784
Name:KNIVETON, CONNIE STREIFINGER (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:STREIFINGER
Last Name:KNIVETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:MARLENE
Other - Last Name:STREIFINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:210 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3915
Mailing Address - Country:US
Mailing Address - Phone:650-579-6581
Mailing Address - Fax:650-579-7851
Practice Address - Street 1:210 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3915
Practice Address - Country:US
Practice Address - Phone:650-579-6581
Practice Address - Fax:650-579-7851
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics