Healthcare Provider Details

I. General information

NPI: 1386507341
Provider Name (Legal Business Name): DR. CHRISTIAN PITALO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CONNOR DR
OCEAN SPRINGS MS
39564-5405
US

IV. Provider business mailing address

109 YELLOWSTONE CIR
OCEAN SPRINGS MS
39564-5831
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-2985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: