Healthcare Provider Details

I. General information

NPI: 1124070743
Provider Name (Legal Business Name): KRISTEN VANDEWALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 C ST SUITE 200-E
SACRAMENTO CA
95816-3300
US

IV. Provider business mailing address

3301 C ST SUITE 200-E
SACRAMENTO CA
95816-3300
US

V. Phone/Fax

Practice location:
  • Phone: 916-447-6267
  • Fax:
Mailing address:
  • Phone: 916-447-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA82271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: