Provider Demographics
NPI:1780971010
Name:CHITAMITARA, PITCHAYA PAM (MD)
Entity type:Individual
Prefix:DR
First Name:PITCHAYA
Middle Name:PAM
Last Name:CHITAMITARA
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 1:1294 W 6TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2990
Mailing Address - Country:US
Mailing Address - Phone:310-548-9118
Mailing Address - Fax:
Practice Address - Street 1:1294 W 6TH ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2990
Practice Address - Country:US
Practice Address - Phone:310-548-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics