MEDICARE: R. ANTONIO WHITELEY L.AC.

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	171100000X	Acupuncturist	AC 11735	CA

General Provider Information

NPI Number	:	1568670289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	R. ANTONIO WHITELEY L.AC.

Provider Business Mailing Address
First Line	:	8315 BEVERLY BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2671
Country	:	US
Telephone Number	:	310-890-6959
Fax Number	:	310-388-0171

Provider Business Practice Location Address
First Line	:	8315 BEVERLY BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2671
Country	:	US
Telephone Number	:	310-890-6959
Fax Number	:	310-388-0171

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	06/08/2022

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