Healthcare Provider Details

I. General information

NPI: 1972059087
Provider Name (Legal Business Name): TITANIUM HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S GRAND AVE SUITE 475
LOS ANGELES CA
90015-3067
US

IV. Provider business mailing address

3223 CAMINO DEL MONTE
CARMEL CA
93923-9307
US

V. Phone/Fax

Practice location:
  • Phone: 323-812-7805
  • Fax:
Mailing address:
  • Phone: 832-368-6461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberGO66140
License Number StateCA

VIII. Authorized Official

Name: MR. GRAY WILLIAM MILLER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 832-368-6461