Healthcare Provider Details

I. General information

NPI: 1528492519
Provider Name (Legal Business Name): REBECCA ANN PITTENGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W DANA ST STE 204
NIPOMO CA
93444-9131
US

IV. Provider business mailing address

151 W DANA ST STE 204
NIPOMO CA
93444-9131
US

V. Phone/Fax

Practice location:
  • Phone: 323-739-8444
  • Fax:
Mailing address:
  • Phone: 323-739-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 25875
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: