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General NPI Number Information
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NPI Number | 1174339626
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Entity Type | Individual
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Provider Name | MICHAEL ANTONIO TITUS JR.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 700 AIRPORT BLVD
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City | BURLINGAME
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State | CA
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Zip | 94010-1908
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Country | US
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Telephone | 415-650-6082
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Fax |
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Provider Business Mailing Address
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Address Line | 931 SAN BRUNO AVE W RM 2
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City | SAN BRUNO
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State | CA
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Zip | 94066-3435
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Country | US
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Telephone | 415-375-7626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | CA
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