Provider Demographics
NPI:1902639867
Name:PITTMAN, CLIFFORD JAMES
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:JAMES
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17271 EASTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6305
Mailing Address - Country:US
Mailing Address - Phone:909-762-9836
Mailing Address - Fax:
Practice Address - Street 1:17271 EASTVIEW DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6305
Practice Address - Country:US
Practice Address - Phone:909-762-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)