Basic Information
| Provider Information | |||||||||
| NPI: | 1841499688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PITRE | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | HC 03 BOX 9121 | ||||||||
| Address2: | |||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878302747 | ||||||||
| FaxNumber: | 7878300465 | ||||||||
| Practice Location | |||||||||
| Address1: | HC 03 BOX 9121 | ||||||||
| Address2: | |||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878302747 | ||||||||
| FaxNumber: | 7878300465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4579 | PR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.