Provider Demographics
NPI:1487148482
Name:HITOTO, MBALULA (ATC)
Entity type:Individual
Prefix:MR
First Name:MBALULA
Middle Name:
Last Name:HITOTO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:MR
Other - First Name:RITCHY
Other - Middle Name:
Other - Last Name:HITOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:14195 MONTEREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6485
Mailing Address - Country:US
Mailing Address - Phone:813-606-0367
Mailing Address - Fax:
Practice Address - Street 1:14195 MONTEREY PINES DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6485
Practice Address - Country:US
Practice Address - Phone:813-606-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer