Healthcare Provider Details

I. General information

NPI: 1083762678
Provider Name (Legal Business Name): JAMES RAFAEL PITTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

1600 9TH ST STE 150
SACRAMENTO CA
95814-6476
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2055
  • Fax:
Mailing address:
  • Phone: 916-651-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA35808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: