Healthcare Provider Details

I. General information

NPI: 1790495000
Provider Name (Legal Business Name): CRISTOPHER BACIERTO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 COFFEE RD STE D3
MODESTO CA
95355-1357
US

IV. Provider business mailing address

3820 DRAGOO PARK DR
MODESTO CA
95356-1845
US

V. Phone/Fax

Practice location:
  • Phone: 844-227-7599
  • Fax: 855-903-5155
Mailing address:
  • Phone: 209-602-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: