Healthcare Provider Details

I. General information

NPI: 1063821247
Provider Name (Legal Business Name): TANYA TITUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 GLENDALE BLVD STE 500
LOS ANGELES CA
90039-1804
US

IV. Provider business mailing address

3020 GLENDALE BLVD STE 500
LOS ANGELES CA
90039-1804
US

V. Phone/Fax

Practice location:
  • Phone: 213-302-6066
  • Fax:
Mailing address:
  • Phone: 213-302-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW103422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: