Provider Demographics
NPI:1811327281
Name:TAIBI, SITA SALINA MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:SITA
Middle Name:SALINA MARIE
Last Name:TAIBI
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3524 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-646-3505
Mailing Address - Fax:541-646-3551
Practice Address - Street 1:3524 HEATHROW WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4004
Practice Address - Country:US
Practice Address - Phone:541-646-3505
Practice Address - Fax:541-646-3551
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR165451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant