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General NPI Number Information
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NPI Number | 1194843383
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Entity Type | Individual
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Provider Name | MARY ANN PITALE AU.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 26302 LA PAZ RD SUITE 107
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5313
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Country | US
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Telephone | 949-855-7898
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Fax | 949-855-1074
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Provider Business Mailing Address
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Address Line | 16 S PORTOLA
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6719
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Country | US
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Telephone | 949-415-1147
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU 1486
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | HA3115
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License Number State | CA
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