Provider Demographics
NPI:1053921957
Name:TITAN PRIMARY CARE, INC
Entity type:Organization
Organization Name:TITAN PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:BUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-738-6372
Mailing Address - Street 1:3753 90TH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7879
Mailing Address - Country:US
Mailing Address - Phone:623-738-6372
Mailing Address - Fax:
Practice Address - Street 1:3753 90TH ST STE 11
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7879
Practice Address - Country:US
Practice Address - Phone:623-738-6372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty