Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Krysten Provencio, PA-C

Individual provider Physician Assistant · NPI 1770350761

Krysten Provencio, PA-C is a Physician Assistant in Laguna Hills, California. Qualified in 2024, 2 years ago. Practices with Valley Perinatal Services LLC, a 60-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
2
Licensed in
CA
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

24012 Calle De La Plata Ste 330
Laguna Hills, CA 92653-7624
Phone: (949) 829-5533
Fax: (949) 581-9158
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 65129 (CA)

Record details

NPI number1770350761
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 8, 2023
Last updated in NPPESJune 28, 2026
Certification dateJune 28, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Valley Perinatal Services Llc — 60 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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