Provider Demographics
NPI:1447852124
Name:TITA, KAISTE
Entity type:Individual
Prefix:
First Name:KAISTE
Middle Name:
Last Name:TITA
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 1:1962 MCNARY BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-1225
Mailing Address - Country:US
Mailing Address - Phone:412-657-8602
Mailing Address - Fax:
Practice Address - Street 1:1606 5TH AVE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:PA
Practice Address - Zip Code:15068-4452
Practice Address - Country:US
Practice Address - Phone:412-657-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA51683601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA51683601Medicaid