Healthcare Provider Details

I. General information

NPI: 1467655100
Provider Name (Legal Business Name): JODY A HITCHMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N ORANGE GROVE AVE #200
POMONA CA
91767
US

IV. Provider business mailing address

110 CALLE RENATA
SAN DIMAS CA
91773
US

V. Phone/Fax

Practice location:
  • Phone: 909-622-6433
  • Fax: 909-469-2524
Mailing address:
  • Phone: 909-599-7281
  • Fax: 909-469-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNP10940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: