Provider Demographics
NPI:1831118900
Name:PITA, ABELARDO (MD)
Entity Type:Individual
Prefix:
First Name:ABELARDO
Middle Name:
Last Name:PITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3277
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:13930 SEAL BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5301
Practice Address - Country:US
Practice Address - Phone:562-430-8888
Practice Address - Fax:562-799-0077
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E90128Medicare UPIN
W11720Medicare PIN