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General NPI Number Information
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NPI Number | 1285227272
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Entity Type | Individual
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Provider Name | GERRY SITU PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 4410 IRVING BLVD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5951
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Country | US
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Telephone | 505-281-5180
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Fax | 505-702-8171
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Provider Business Mailing Address
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Address Line | 12127B HWY 14 N STE 5
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City | CEDAR CREST
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State | NM
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Zip | 87008-9557
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Country | US
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Telephone | 505-286-2396
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Fax | 505-286-2398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2021-0077
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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