Provider Demographics
NPI:1194387258
Name:PITTMAN, ASTRO NICHOLAS (CDPT)
Entity Type:Individual
Prefix:
First Name:ASTRO
Middle Name:NICHOLAS
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:CDPT
Other - Prefix:
Other - First Name:EDRICK
Other - Middle Name:NICHOLAS
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDPT
Mailing Address - Street 1:861 POPLAR PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2827
Mailing Address - Country:US
Mailing Address - Phone:206-223-9578
Mailing Address - Fax:206-838-1851
Practice Address - Street 1:861 POPLAR PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2827
Practice Address - Country:US
Practice Address - Phone:206-223-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60943555390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program