| Organization Name: | SITI MEDICAL CLINIC |
| NPI Number: | 1790088219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN ANN KINCAID (PART OWNER/ MANGER) |
| Mailing Address: | 1951 4th Ave Ste 202 San Diego |
| State: | CA US |
| Postal Code: | 921012374 |
| Phone Number: | 6197178484 |
| Fax Number: | |
| NPI Enumeration Date: | 12/07/2010 |
| NPI Last Update Date: | 12/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364S00000X |
| License Number: | 18150 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |