Provider Demographics
NPI:1740254366
Name:PITZER, JO ELLEN (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:PITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 E LA PALMA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:714-970-9900
Mailing Address - Fax:714-970-9906
Practice Address - Street 1:8078 E SANTA ANA CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1108
Practice Address - Country:US
Practice Address - Phone:714-974-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA75285BMedicare ID - Type Unspecified
X64297Medicare UPIN