Healthcare Provider Details

I. General information

NPI: 1073076782
Provider Name (Legal Business Name): KENTSTON CRIPE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 CIRBY WAY STE 100
ROSEVILLE CA
95661-4475
US

IV. Provider business mailing address

906 CIRBY WAY STE 100
ROSEVILLE CA
95661-4475
US

V. Phone/Fax

Practice location:
  • Phone: 916-243-5033
  • Fax: 916-898-0051
Mailing address:
  • Phone: 916-243-5033
  • Fax: 916-898-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: