Healthcare Provider Details

I. General information

NPI: 1992987259
Provider Name (Legal Business Name): KRISTINE ANN REBIERO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SCENIC DR
MODESTO CA
95350-6133
US

IV. Provider business mailing address

830 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-7698
  • Fax:
Mailing address:
  • Phone: 209-558-8400
  • Fax: 209-558-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number17922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: