=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285021733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTA AYUMI CAETTA-STIFFLER LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2015
-----------------------------------------------------
Last Update Date | 04/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8350 E YALE AVE APT G308
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80231-3867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-841-6475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8350 E YALE AVE APT G308
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80231-3867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-841-6475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | MT.0012762
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------