Provider Demographics
NPI:1578731816
Name:PITA, IVAN
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:PITA
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 1:3750 W 16TH AVE
Mailing Address - Street 2:SUITE 130 AU
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4654
Mailing Address - Country:US
Mailing Address - Phone:786-367-7786
Mailing Address - Fax:
Practice Address - Street 1:3750 W 16TH AVE
Practice Address - Street 2:SUITE 130 AU
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4654
Practice Address - Country:US
Practice Address - Phone:786-367-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies