Provider Demographics
NPI:1154064640
Name:PITTMAN-BORLAND, ANGELSHANTELLE RENEE
Entity Type:Individual
Prefix:
First Name:ANGELSHANTELLE
Middle Name:RENEE
Last Name:PITTMAN-BORLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANTELLE
Other - Middle Name:RENEE
Other - Last Name:PITTMAN-BORLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:10015 LAKEWOOD DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3838
Practice Address - Country:US
Practice Address - Phone:855-223-7123
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician