MEDICARE: CAITLIN BROOKS PITECK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95025641	CA

General Provider Information

NPI Number	:	1528749124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN BROOKS PITECK NP

Provider Business Mailing Address
First Line	:	1037 OPAL ST APT 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1874
Country	:	US
Telephone Number	:	801-599-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 OPAL ST APT 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1874
Country	:	US
Telephone Number	:	801-599-4551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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