Healthcare Provider Details

I. General information

NPI: 1972636405
Provider Name (Legal Business Name): DR. AURORA LITAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AURORA MONDOK-LITAM M.D.

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EASTLAKE AVE MEDICAL MODULE
LOS ANGELES CA
90033-1009
US

IV. Provider business mailing address

1052 SHIRLYJEAN ST
GLENDALE CA
91208-1140
US

V. Phone/Fax

Practice location:
  • Phone: 323-228-8816
  • Fax: 323-227-4723
Mailing address:
  • Phone: 232-226-8816
  • Fax: 232-227-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA048364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: