Provider Demographics
NPI:1194843383
Name:PITALE, MARY ANN (AUD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:PITALE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S PORTOLA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6719
Mailing Address - Country:US
Mailing Address - Phone:949-415-1147
Mailing Address - Fax:
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5313
Practice Address - Country:US
Practice Address - Phone:949-855-7898
Practice Address - Fax:949-855-1074
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1486231H00000X
CAHA3115237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist