Provider Demographics
NPI:1134313182
Name:JEROLD T. LITOFF, M.D. A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:JEROLD T. LITOFF, M.D. A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:LITOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-527-3222
Mailing Address - Street 1:2925 SYCAMORE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1207
Mailing Address - Country:US
Mailing Address - Phone:805-527-3222
Mailing Address - Fax:805-582-2651
Practice Address - Street 1:2925 SYCAMORE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1207
Practice Address - Country:US
Practice Address - Phone:805-527-3222
Practice Address - Fax:805-582-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29343204C00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293430Medicaid
CAA25723Medicare UPIN
0602970001Medicare NSC
CA00A293430Medicaid