Healthcare Provider Details

I. General information

NPI: 1538132428
Provider Name (Legal Business Name): DR. DAVID FEDERICO FITTANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 CABRILLO ST. SUITE A1A U.S. ARMY HEALTH CLINIC
MONTEREY CA
93944-3208
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 REID ST.. ATTN; MCHJ-QCR
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 831-242-7581
  • Fax:
Mailing address:
  • Phone: 253-968-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY6902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: