Provider Demographics
NPI:1619369253
Name:MITITI, CRISTIAN IOAN
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:IOAN
Last Name:MITITI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8429 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0423
Mailing Address - Country:US
Mailing Address - Phone:916-475-4430
Mailing Address - Fax:
Practice Address - Street 1:5210 FLORIN PERKINS RD
Practice Address - Street 2:A3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-4818
Practice Address - Country:US
Practice Address - Phone:916-475-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47-1940015343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)