Provider Demographics
NPI:1538132428
Name:FITTANTE, DAVID FEDERICO
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FEDERICO
Last Name:FITTANTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Mailing Address - Street 2:9040 REID ST.. ATTN; MCHJ-QCR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-2252
Mailing Address - Fax:
Practice Address - Street 1:473 CABRILLO ST.
Practice Address - Street 2:SUITE A1A U.S. ARMY HEALTH CLINIC
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3208
Practice Address - Country:US
Practice Address - Phone:831-242-7581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6902103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical