Individual provider Active NPI

Kristen Petti, PA-C

  • Physician Assistant
  • Moreno Valley, CA
National Provider Identifier
1548828809
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
67696 Issued in CA
Practice address
26600 Cactus Ave
Moreno Valley, CA 92555-3901
Phone
(951) 988-9500
NPI assigned
Jun 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 67696 CA Primary

Addresses

Primary practice location

26600 Cactus Ave
Moreno Valley, CA 92555-3901

Mailing address

6715 Goldy St
Corona, CA 92880-9281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260314000231 CA Practitioner - Physician Assistant 5799268074 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of RiversideGroup PAC ID 6507754488, shared by 16 NPIs, 190 clinicians

Practice addresses (Care Compare)

26600 Cactus Ave
Moreno Valley, CA 92555-3901

7140 Indiana Ave
Riverside, CA 92504-4544
Phone (951) 358-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
67696CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-California CurrentSince Feb 27, 2026 Accepting new patients
Cep America - California CurrentSince Feb 27, 2026 Accepting new patients

Locations

26520 Cactus Ave
Moreno Valley, CA 92555
Phone (951) 486-5610

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1548828809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6715 GOLDY ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928809281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26600 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553901",
            "telephone_number": "951-988-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTI",
        "first_name": "KRISTEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-02",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "67696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.