Provider Demographics
NPI:1861847105
Name:SITA, KUBURA
Entity Type:Individual
Prefix:
First Name:KUBURA
Middle Name:
Last Name:SITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3530
Mailing Address - Country:US
Mailing Address - Phone:216-688-6995
Mailing Address - Fax:
Practice Address - Street 1:5608 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3530
Practice Address - Country:US
Practice Address - Phone:216-688-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3143904374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3143904Medicaid