Provider Demographics
NPI:1760912539
Name:PITCOCK, CARRIE MARIE
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:MARIE
Last Name:PITCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 JOSIE ST
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-9106
Mailing Address - Country:US
Mailing Address - Phone:209-761-6307
Mailing Address - Fax:
Practice Address - Street 1:6235 JOSIE ST
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-9106
Practice Address - Country:US
Practice Address - Phone:209-761-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201712910212347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker