Provider Demographics
NPI:1124515101
Name:CRESTA, KATELYN (DC)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:CRESTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2135
Mailing Address - Country:US
Mailing Address - Phone:650-454-6103
Mailing Address - Fax:
Practice Address - Street 1:536 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1212
Practice Address - Country:US
Practice Address - Phone:650-853-1800
Practice Address - Fax:650-853-1801
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor