Healthcare Provider Details

I. General information

NPI: 1215847116
Provider Name (Legal Business Name): KRISTEN WITTE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18837 BROOKHURST STREET SUITE 210
FOUNTAIN VALLEY CA
92708-7302
US

IV. Provider business mailing address

18837 BROOKHURST STREET SUITE 210
FOUNTAIN VALLEY CA
92708-7302
US

V. Phone/Fax

Practice location:
  • Phone: 714-965-5145
  • Fax: 714-965-5148
Mailing address:
  • Phone: 714-965-5145
  • Fax: 714-965-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCMT71070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: