Healthcare Provider Details

I. General information

NPI: 1164353421
Provider Name (Legal Business Name): KRISTINE SCALZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ORCHARD AVE
ARROYO GRANDE CA
93420-4000
US

IV. Provider business mailing address

1170 REFUGIO ST
GROVER BEACH CA
93433-3245
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-3000
  • Fax:
Mailing address:
  • Phone: 805-458-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: