Healthcare Provider Details

I. General information

NPI: 1245864297
Provider Name (Legal Business Name): KRISTIN JEAN GEDDA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN LAMASTERS PA-C

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 DOYLE PARK DR
SANTA ROSA CA
95405-4570
US

IV. Provider business mailing address

2700 BELL ST
SACRAMENTO CA
95821-4619
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-8323
  • Fax:
Mailing address:
  • Phone: 530-383-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: