Provider Demographics
NPI:1407013162
Name:PITTS, KRISTEN CAROL (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CAROL
Last Name:PITTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 ROCKFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2801
Mailing Address - Country:US
Mailing Address - Phone:949-457-9900
Mailing Address - Fax:949-457-9922
Practice Address - Street 1:15701 ROCKFIELD BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2801
Practice Address - Country:US
Practice Address - Phone:949-457-9900
Practice Address - Fax:949-457-9922
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist