Individual
KRISTINE MAE FADDISSTUART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
590 TOYANZA DRIVE, SAN ANDREAS, CA 95249-9713
(209) 754-6562
Mailing address
1825 LIVE OAK DR, VALLECITO, CA 95251-9603
(209) 256-0249
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-RMODKG
CA
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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