Provider Demographics
NPI:1528749124
Name:PITECK, CAITLIN BROOKS (NP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BROOKS
Last Name:PITECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 OPAL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1874
Mailing Address - Country:US
Mailing Address - Phone:801-599-4551
Mailing Address - Fax:
Practice Address - Street 1:1037 OPAL ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1874
Practice Address - Country:US
Practice Address - Phone:801-599-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily