Healthcare Provider Details

I. General information

NPI: 1285034199
Provider Name (Legal Business Name): VARINTHREJ PITIS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

3435 OCEAN PARK BLVD #107, PMB 679
SANTA MONICA CA
90405-3301
US

V. Phone/Fax

Practice location:
  • Phone: 312-925-3183
  • Fax:
Mailing address:
  • Phone: 312-925-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA122811
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA122811
License Number StateCA

VIII. Authorized Official

Name: DR. VARINTHREJ PITIS
Title or Position: CEO
Credential: M.D.
Phone: 312-925-3183