Provider Demographics
NPI:1861757080
Name:SAGE, KRISTINA LEA (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEA
Last Name:SAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LEA
Other - Last Name:MALLECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3398 S NUCLA WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2021
Mailing Address - Country:US
Mailing Address - Phone:303-332-5238
Mailing Address - Fax:
Practice Address - Street 1:2525 CHARLESTON RD STE 104
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1636
Practice Address - Country:US
Practice Address - Phone:408-675-3255
Practice Address - Fax:650-509-3151
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003478363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical