Provider Demographics
NPI:1710952544
Name:LITOFF, JEROLD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:THOMAS
Last Name:LITOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 N. SYCAMORE DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1208
Mailing Address - Country:US
Mailing Address - Phone:805-527-3222
Mailing Address - Fax:805-582-2651
Practice Address - Street 1:2925 N. SYCAMORE DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1208
Practice Address - Country:US
Practice Address - Phone:805-527-3222
Practice Address - Fax:805-582-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29343204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293430Medicaid
CA0602970001Medicare NSC
CAA29343Medicare PIN
CA00A293430Medicaid
CAA29343AMedicare PIN