Healthcare Provider Details

I. General information

NPI: 1538653571
Provider Name (Legal Business Name): KRISTINA A SIT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 EAST ST
CONCORD CA
94520-1960
US

IV. Provider business mailing address

945 N 12TH ST
MILWAUKEE WI
53233-1305
US

V. Phone/Fax

Practice location:
  • Phone: 925-674-2333
  • Fax:
Mailing address:
  • Phone: 414-219-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4437
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: