Healthcare Provider Details

I. General information

NPI: 1578154787
Provider Name (Legal Business Name): JULIE PITOIS MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 01/30/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 GARNET AVE FL 3
SAN DIEGO CA
92109-3826
US

IV. Provider business mailing address

2949 GARNET AVE FL 3
SAN DIEGO CA
92109-3826
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-5577
  • Fax:
Mailing address:
  • Phone: 619-255-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number79222
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number79222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: