Provider Demographics
NPI:1164634259
Name:MEN, PITOU
Entity Type:Individual
Prefix:MR
First Name:PITOU
Middle Name:
Last Name:MEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 GUNDRY AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2338
Mailing Address - Country:US
Mailing Address - Phone:562-733-1147
Mailing Address - Fax:562-733-1157
Practice Address - Street 1:1301 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2720
Practice Address - Country:US
Practice Address - Phone:562-733-1147
Practice Address - Fax:562-733-1157
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management