Provider Demographics
NPI:1982666905
Name:TITOV, VLADIMIR A (MD PHD)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:A
Last Name:TITOV
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 DALLAS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8811
Mailing Address - Country:US
Mailing Address - Phone:925-778-0679
Mailing Address - Fax:925-778-3567
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-351-1193
Practice Address - Fax:510-351-6456
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15328ZOtherPTAN
CA110006522OtherPTAN
CAA56479Medicare PIN
CAZZZ15328ZOtherPTAN