Provider Demographics
NPI:1922450857
Name:DEBATTISTA, KRISTINA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:DEBATTISTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DEL MONTE RD
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-4916
Mailing Address - Country:US
Mailing Address - Phone:650-533-2355
Mailing Address - Fax:
Practice Address - Street 1:115 DEL MONTE RD
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-4916
Practice Address - Country:US
Practice Address - Phone:650-533-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist