Healthcare Provider Details

I. General information

NPI: 1225600034
Provider Name (Legal Business Name): KRISTOPHER BRYAN OKIALDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 01/25/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5477
US

IV. Provider business mailing address

10570 TRILL WAY
ELK GROVE CA
95757-6491
US

V. Phone/Fax

Practice location:
  • Phone: 510-935-6500
  • Fax:
Mailing address:
  • Phone: 510-935-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95170173
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: