Healthcare Provider Details

I. General information

NPI: 1457659187
Provider Name (Legal Business Name): KRISTINE KELLY NEMES D.P.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 CRESPI DR SUITE B
PACIFICA CA
94044-3486
US

IV. Provider business mailing address

669 CRESPI DR SUITE B
PACIFICA CA
94044-3486
US

V. Phone/Fax

Practice location:
  • Phone: 650-359-7770
  • Fax: 650-359-3449
Mailing address:
  • Phone: 650-359-7770
  • Fax: 650-359-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4584
License Number StateCA

VIII. Authorized Official

Name: DR. KRISTINE KELLY NEMES
Title or Position: PRESIDENT
Credential: DPM
Phone: 650-359-7770