Provider Information for 1962994038
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
Mrs. IDA LUCILLE WHITAKER
Sex: Female
NPI: 1962994038
Last Updated: 2018-06-04
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1962994038 | ||||||||
| Enumeration Date | 2018-06-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 615 ALLISON LN SAN MARCOS, CA 92069-6516 United States Phone: 619-454-0602 | Fax: | ||||||||
| Primary Practice Address | 1002 E GRAND AVE ESCONDIDO, CA 92025-4605 United States Phone: 760-741-2660 | Fax:760-741-2647 | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|