Provider Demographics
NPI:1972636405
Name:LITAM, AURORA
Entity type:Individual
Prefix:DR
First Name:AURORA
Middle Name:
Last Name:LITAM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:AURORA
Other - Middle Name:
Other - Last Name:MONDOK-LITAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1052 SHIRLYJEAN ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1140
Mailing Address - Country:US
Mailing Address - Phone:232-226-8816
Mailing Address - Fax:232-227-4723
Practice Address - Street 1:1605 EASTLAKE AVE
Practice Address - Street 2:MEDICAL MODULE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1009
Practice Address - Country:US
Practice Address - Phone:323-228-8816
Practice Address - Fax:323-227-4723
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA048364208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics