Healthcare Provider Details

I. General information

NPI: 1295298115
Provider Name (Legal Business Name): SITKA MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 01/31/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BUENA VISTA
STINSON BEACH CA
94970-5730
US

IV. Provider business mailing address

75 BUENA VISTA
STINSON BEACH CA
94970-5730
US

V. Phone/Fax

Practice location:
  • Phone: 813-530-8760
  • Fax:
Mailing address:
  • Phone: 813-530-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD ALAN GREENO
Title or Position: PRESIDENT
Credential:
Phone: 323-646-3188