MEDICARE: PAUL B WHITTEMORE 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	PSY11060	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073887816	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1528130010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL B WHITTEMORE PHD

Provider Business Mailing Address
First Line	:	4250 PARK NEWPORT APT 406
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6052
Country	:	US
Telephone Number	:	949-290-3518
Fax Number	:	949-752-6463

Provider Business Practice Location Address
First Line	:	4250 PARK NEWPORT APT 406
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6052
Country	:	US
Telephone Number	:	949-290-3518
Fax Number	:	949-752-6463

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	01/28/2023

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