Basic Information
| Provider Information | |||||||||
| NPI: | 1720518822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SISSON | ||||||||
| FirstName: | CHRISTA | ||||||||
| MiddleName: | TOTTY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MCD, CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TOTTY | ||||||||
| OtherFirstName: | CHRISTA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MCD, CF-SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7845 WESTSIDE DR APT 114 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319947714 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7090 MIRATECH DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921213109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583046440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 235Z00000X | 27812 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.