Provider Demographics
NPI:1255885224
Name:MALITZ, TRISTA
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:MALITZ
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 1:310 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9689
Mailing Address - Country:US
Mailing Address - Phone:517-881-6964
Mailing Address - Fax:
Practice Address - Street 1:310 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9689
Practice Address - Country:US
Practice Address - Phone:517-881-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other