Provider Demographics
NPI:1962919522
Name:PITTARI, RUTH CATHERINE
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:CATHERINE
Last Name:PITTARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 FRANCES TER
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4711
Mailing Address - Country:US
Mailing Address - Phone:214-957-2887
Mailing Address - Fax:
Practice Address - Street 1:420 FRANCES TER
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4711
Practice Address - Country:US
Practice Address - Phone:214-957-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747A0650X
251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251F00000XAgenciesHome InfusionGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty