1518469352 NPI number — KRISTOPHER KLEIN CLEMENO MSN, RN, CNS

Table of content: KRISTOPHER KLEIN CLEMENO MSN, RN, CNS (NPI 1518469352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518469352 NPI number — KRISTOPHER KLEIN CLEMENO MSN, RN, CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENO
Provider First Name:
KRISTOPHER KLEIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CNS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518469352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/16/2024
NPI Reactivation Date:
04/22/2026

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2025 MORSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-973-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 MORSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-683-1109
Provider Business Practice Location Address Fax Number:
916-683-1140
Provider Enumeration Date:
03/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364S00000X , with the licence number:  5118 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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