Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A29343 | CA |
NPI | 1710952544 |
---|---|
Provider Name | Dr. Jerold Thomas Litoff |
First Address | Simi Valley, CA 93065-1208 |
Second Address | Simi Valley, CA 93065-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 01/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A293430 | (05) | CA |
A25723 | (02) | CA |