Provider Demographics
NPI:1285034199
Name:VARINTHREJ PITIS MD INC
Entity Type:Organization
Organization Name:VARINTHREJ PITIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VARINTHREJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-925-3183
Mailing Address - Street 1:3435 OCEAN PARK BLVD
Mailing Address - Street 2:#107, PMB 679
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3301
Mailing Address - Country:US
Mailing Address - Phone:312-925-3183
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:312-925-3183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122811207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty