MEDICARE: MRS. KRISTIN ELIZABETH BORDESSA RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		CA

General Provider Information

NPI Number	:	1326983453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN ELIZABETH BORDESSA RDN, LD

Provider Business Mailing Address
First Line	:	344 KENTUCKY ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2843
Country	:	US
Telephone Number	:	707-477-4896
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 KENTUCKY ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-2843
Country	:	US
Telephone Number	:	707-477-4796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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