Healthcare Provider Details

I. General information

NPI: 1710992284
Provider Name (Legal Business Name): PAUL PITLICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD MC 5500
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

725 WELCH RD MC 5500
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-2791
  • Fax:
Mailing address:
  • Phone: 650-723-7913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG21607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: