Healthcare Provider Details

I. General information

NPI: 1760845903
Provider Name (Legal Business Name): KRISTIN MOSCHETTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BON AIR RD STE 105
LARKSPUR CA
94939-1137
US

IV. Provider business mailing address

5 BON AIR RD STE 105
LARKSPUR CA
94939-1137
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-0440
  • Fax:
Mailing address:
  • Phone: 415-461-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA150786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: