Provider Demographics
NPI:1134459126
Name:MCNITT, CAROLYN M (PT)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:M
Last Name:MCNITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2722
Mailing Address - Country:US
Mailing Address - Phone:310-740-5080
Mailing Address - Fax:
Practice Address - Street 1:170 N CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2722
Practice Address - Country:US
Practice Address - Phone:310-740-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist