MEDICARE: DR. PAUL MCCOLES WHITAKER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY14205	CA

General Provider Information

NPI Number	:	1356339964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MCCOLES WHITAKER PHD

Provider Business Mailing Address
First Line	:	3529 32ND ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4302
Country	:	US
Telephone Number	:	619-204-2382
Fax Number	:	619-692-0299

Provider Business Practice Location Address
First Line	:	4420 HOTEL CIRCLE CT
Second Line	:	SUITE 235
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3411
Country	:	US
Telephone Number	:	619-204-2382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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