Provider Demographics
NPI:1629176490
Name:PITZER FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:PITZER FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JO
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:714-970-9900
Mailing Address - Street 1:5475 E LA PALMA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-970-9900
Mailing Address - Fax:714-970-9906
Practice Address - Street 1:5475 E LA PALMA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-970-9900
Practice Address - Fax:714-970-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740254366OtherNPI INDIVIDUAL
X64297Medicare UPIN
WA75285BMedicare ID - Type Unspecified