Healthcare Provider Details

I. General information

NPI: 1710952544
Provider Name (Legal Business Name): JEROLD THOMAS LITOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 N. SYCAMORE DRIVE SUITE 202
SIMI VALLEY CA
93065-1208
US

IV. Provider business mailing address

2925 N. SYCAMORE DRIVE SUITE 202
SIMI VALLEY CA
93065-1208
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-3222
  • Fax: 805-582-2651
Mailing address:
  • Phone: 805-527-3222
  • Fax: 805-582-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA29343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: