Healthcare Provider Details

I. General information

NPI: 1487091609
Provider Name (Legal Business Name): CHRISTINA KYTASTY CHATYRKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA KYTASTY D.O.

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20A15419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: