MEDICARE: KRISTINA DORONILA GADDI

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	164X00000X	Licensed Vocational Nurse	682263	CA

General Provider Information

NPI Number	:	1679920227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA DORONILA GADDI

Provider Business Mailing Address
First Line	:	1308 EAST CAMBRIDGE CT
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535
Country	:	US
Telephone Number	:	661-247-3054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 EAST CAMBRIDGE CT
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93535
Country	:	US
Telephone Number	:	661-247-3054
Fax Number	:

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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