Healthcare Provider Details

I. General information

NPI: 1134313182
Provider Name (Legal Business Name): JEROLD T. LITOFF, M.D. A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 SYCAMORE DR SUITE 202
SIMI VALLEY CA
93065-1207
US

IV. Provider business mailing address

2925 SYCAMORE DR SUITE 202
SIMI VALLEY CA
93065-1207
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 TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA29343
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA29343
License Number StateCA

VIII. Authorized Official

Name: JEROLD LITOFF
Title or Position: OFFICER
Credential: M.D.
Phone: 805-527-3222