Healthcare Provider Details

I. General information

NPI: 1700424751
Provider Name (Legal Business Name): MR. ROBERT LOY PITTS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 BUHNE ST
EUREKA CA
95501-3237
US

IV. Provider business mailing address

2370 BUHNE ST
EUREKA CA
95501-3237
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-5721
  • Fax: 707-442-4812
Mailing address:
  • Phone: 707-442-5721
  • Fax: 707-442-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: