Provider Demographics
NPI:1053030494
Name:SITU, JACINTA NYSSA (RPH)
Entity type:Individual
Prefix:
First Name:JACINTA
Middle Name:NYSSA
Last Name:SITU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5328 MCCULLOCH AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3580
Mailing Address - Country:US
Mailing Address - Phone:626-233-6885
Mailing Address - Fax:
Practice Address - Street 1:2103 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6801
Practice Address - Country:US
Practice Address - Phone:323-268-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist