Healthcare Provider Details

I. General information

NPI: 1518469352
Provider Name (Legal Business Name): KRISTOPHER KLEIN CLEMENO MSN, RN, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date: 04/16/2024
Reactivation Date: 04/22/2026

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

V. Phone/Fax

Practice location:
  • Phone: 916-683-1109
  • Fax: 916-683-1140
Mailing address:
  • Phone: 916-973-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number5118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: