Healthcare Provider Details

I. General information

NPI: 1669868964
Provider Name (Legal Business Name): COREY JOSEPH HITI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 LAS TABLAS RD ST 103
TEMPLETON CA
93465
US

IV. Provider business mailing address

1310 LAS TABLAS RD STE 206
TEMPLETON CA
93465-9747
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-0829
  • Fax:
Mailing address:
  • Phone: 805-461-7080
  • Fax: 805-464-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA146529
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number61006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: