Healthcare Provider Details

I. General information

NPI: 1780739136
Provider Name (Legal Business Name): TITUS CHUKWUNETE OGBUAFOR COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 COUNTY CIRCLE DR RM 47
RIVERSIDE CA
92503-3410
US

IV. Provider business mailing address

1849 MADERA CIR
CORONA CA
92879-8210
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4609
  • Fax: 951-358-4776
Mailing address:
  • Phone: 951-602-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: