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General NPI Number Information
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NPI Number | 1093057168
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Entity Type | Individual
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Provider Name | STEPHEN E PITUCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 14 MONARCH BAY PLZ #493
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City | DANA POINT
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State | CA
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Zip | 92629-3424
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Country | US
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Telephone | 949-499-4903
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MONARCH BAY PLZ #493
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City | DANA POINT
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State | CA
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Zip | 92629-3424
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Country | US
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Telephone | 949-499-4903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G56100
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License Number State | CA
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