Provider Demographics
NPI:1982755724
Name:TITUS, MAUREEN ROBERTA (RDHAP, BS)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ROBERTA
Last Name:TITUS
Suffix:
Gender:F
Credentials:RDHAP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1332
Mailing Address - Country:US
Mailing Address - Phone:805-528-0612
Mailing Address - Fax:805-528-0612
Practice Address - Street 1:1326 11TH ST
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1332
Practice Address - Country:US
Practice Address - Phone:805-528-0612
Practice Address - Fax:805-528-0612
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP 119124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00119-01OtherRDHAP