Provider Demographics
NPI:1497196729
Name:SUNA-SITTO, MOHEEN (PA)
Entity Type:Individual
Prefix:
First Name:MOHEEN
Middle Name:
Last Name:SUNA-SITTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72724 29 PALMS HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2417
Mailing Address - Country:US
Mailing Address - Phone:760-367-5906
Mailing Address - Fax:760-367-5986
Practice Address - Street 1:72724 29 PALMS HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2417
Practice Address - Country:US
Practice Address - Phone:760-367-5906
Practice Address - Fax:760-367-5986
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant