Healthcare Provider Details

I. General information

NPI: 1508336892
Provider Name (Legal Business Name): PRIYA JITTU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N DOUGLAS ST
EL SEGUNDO CA
90245-4637
US

IV. Provider business mailing address

13534 CORDARY AVE UNIT 5
HAWTHORNE CA
90250-7459
US

V. Phone/Fax

Practice location:
  • Phone: 310-725-5800
  • Fax:
Mailing address:
  • Phone: 818-571-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: