Healthcare Provider Details

I. General information

NPI: 1720518822
Provider Name (Legal Business Name): CHRISTA TOTTY SISSON MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA MARIE TOTTY MCD, CF-SLP

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 MIRATECH DR
SAN DIEGO CA
92121-3109
US

IV. Provider business mailing address

7845 WESTSIDE DR APT 114
SAN DIEGO CA
92108-1249
US

V. Phone/Fax

Practice location:
  • Phone: 858-304-6440
  • Fax:
Mailing address:
  • Phone: 931-994-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27812
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: