Healthcare Provider Details

I. General information

NPI: 1538934823
Provider Name (Legal Business Name): KRISTI HEFFELFINGER RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY STE 190
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

3642 HEMLOCK CT
SANTA ROSA CA
95403-1546
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3755
  • Fax:
Mailing address:
  • Phone: 831-402-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number19083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: