=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306760731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARISSA FLUITT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2026
-----------------------------------------------------
Last Update Date | 08/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 E CAMINO COLEGIO
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-6752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-361-7560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 398 VILLAGE GLEN DR
-----------------------------------------------------
City | ARROYO GRANDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93420-2106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-513-2792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 37653
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------