Provider Demographics
NPI:1871108597
Name:DIBENEDETTO, KIRSTEN (NP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BATH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4339
Mailing Address - Country:US
Mailing Address - Phone:805-898-4443
Mailing Address - Fax:805-682-7265
Practice Address - Street 1:2320 BATH ST STE 317
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4389
Practice Address - Country:US
Practice Address - Phone:805-898-4443
Practice Address - Fax:805-682-7265
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014854363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health