Provider Demographics
NPI:1538584081
Name:HITT, WENDY ALICIA (DO, DPT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ALICIA
Last Name:HITT
Suffix:
Gender:F
Credentials:DO, DPT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:MATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:26520 CACTUS AVE RM MS 2117
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-4753
Mailing Address - Fax:951-486-4560
Practice Address - Street 1:26520 CACTUS AVE RM MS 2117
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
R174987Medicare PIN