Provider Demographics
NPI:1366879041
Name:TITOVA, ELENA (CPT-1, EKG TECH)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:TITOVA
Suffix:
Gender:F
Credentials:CPT-1, EKG TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11284 DEMARET DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7430
Mailing Address - Country:US
Mailing Address - Phone:909-831-1083
Mailing Address - Fax:909-795-4259
Practice Address - Street 1:34050 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2602
Practice Address - Country:US
Practice Address - Phone:909-795-4259
Practice Address - Fax:909-795-4259
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT59788246RP1900X
246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology