Provider Demographics
NPI:1790704344
Name:LITVAK, DONALD STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:STEPHEN
Last Name:LITVAK
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 1:3808 WINFORD DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5824
Mailing Address - Country:US
Mailing Address - Phone:818-343-9802
Mailing Address - Fax:818-343-9804
Practice Address - Street 1:3808 WINFORD DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-5824
Practice Address - Country:US
Practice Address - Phone:818-343-9802
Practice Address - Fax:818-343-9804
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23815174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA23815EMedicare PIN
CAA23701Medicare UPIN