Provider Demographics
NPI:1285021733
Name:CAETTA-STIFFLER, KRISTA AYUMI (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:AYUMI
Last Name:CAETTA-STIFFLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:CARTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:8350 E YALE AVE APT G308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3867
Mailing Address - Country:US
Mailing Address - Phone:720-841-6475
Mailing Address - Fax:
Practice Address - Street 1:8350 E YALE AVE APT G308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3867
Practice Address - Country:US
Practice Address - Phone:720-841-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012762171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor