Healthcare Provider Details

I. General information

NPI: 1053376103
Provider Name (Legal Business Name): HARLEY S SCHULTZ MD & VLADIMIR A TITOV MD PHD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH #216
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

13847 E 14TH #216
SAN LEANDRO CA
94578
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-1193
  • Fax: 510-351-6456
Mailing address:
  • Phone: 510-351-1193
  • Fax: 510-351-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA56479
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG36475
License Number StateCA

VIII. Authorized Official

Name: HARLEY S SCHULTZ
Title or Position: PARTNER
Credential: MD
Phone: 510-351-1193