Provider Demographics
NPI:1447575980
Name:PITTI, GRETCHEN LEE (RN, CWON)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:LEE
Last Name:PITTI
Suffix:
Gender:F
Credentials:RN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15311 KNOLLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2753
Mailing Address - Country:US
Mailing Address - Phone:714-206-5536
Mailing Address - Fax:
Practice Address - Street 1:15311 KNOLLWOOD CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2753
Practice Address - Country:US
Practice Address - Phone:714-206-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316780163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy