Provider Information for 1114436102
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WHITNEY ANN PAINE
Sex: Female
NPI: 1114436102
Last Updated: 2023-03-13
Certification Date: 2023-03-13
Certification Date: 2023-03-13
Details
| Name | Value | ||||||||||||||||
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| NPI | 1114436102 | ||||||||||||||||
| Enumeration Date | 2017-09-22 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 1907 BOYS REPUBLIC DR CHINO HILLS, CA 91709-5447 United States Phone: 909-628-1217 | Fax:909-306-5427 | ||||||||||||||||
| Primary Practice Address | 184 N IVY AVE MONROVIA, CA 91016-2220 United States Phone: 626-357-0957 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 1907 BOYS REPUBLIC DR 184 N IVY AVE | ||||||||||||||||
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