MEDICARE: KRISTA GERDTS

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	106H00000X	Marriage & Family Therapist	141104	CA

General Provider Information

NPI Number	:	1508641648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA GERDTS

Provider Business Mailing Address
First Line	:	1023 ASHLAND AVE APT 5
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-4638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 ASHLAND AVE APT 5
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-4638
Country	:	US
Telephone Number	:	805-754-4848
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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Directions to “ KRISTA GERDTS ” Practice Location

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