Provider Demographics
NPI:1841397700
Name:PITT, ROSE MARIE ANGELLA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE MARIE
Middle Name:ANGELLA
Last Name:PITT
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 1:131 N TUSTIN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2926
Mailing Address - Country:US
Mailing Address - Phone:714-547-8611
Mailing Address - Fax:714-547-8640
Practice Address - Street 1:14181 YORBA ST STE 110
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2054
Practice Address - Country:US
Practice Address - Phone:714-547-8611
Practice Address - Fax:714-547-8640
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG063342174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG063342OtherINS ID NO
CAG063342Medicare ID - Type UnspecifiedMEDICARE ID. NO
CAG063342OtherINS ID NO
CAF26912Medicare UPIN