Healthcare Provider Details

I. General information

NPI: 1295207017
Provider Name (Legal Business Name): KITZIA CRIADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 WINDBRIDGE DR APT 130
SACRAMENTO CA
95831-5216
US

IV. Provider business mailing address

7525 WINDBRIDGE DR APT 130
SACRAMENTO CA
95831-5216
US

V. Phone/Fax

Practice location:
  • Phone: 831-821-0571
  • Fax:
Mailing address:
  • Phone: 831-821-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number25227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: