Healthcare Provider Details

I. General information

NPI: 1437687530
Provider Name (Legal Business Name): KRISTIN COURTNEY OKITA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3650 MEIER ST
LOS ANGELES CA
90066-3612
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2450
  • Fax:
Mailing address:
  • Phone: 310-384-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: