Healthcare Provider Details

I. General information

NPI: 1649275868
Provider Name (Legal Business Name): PIH HEALTH WHITTIER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15050 IMPERIAL HIGHWAY
LA MIRADA CA
90638-1301
US

IV. Provider business mailing address

15050 IMPERIAL HIGHWAY
LA MIRADA CA
90638-1301
US

V. Phone/Fax

Practice location:
  • Phone: 562-902-7763
  • Fax: 562-902-7787
Mailing address:
  • Phone: 562-902-7763
  • Fax: 562-902-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980000525
License Number StateCA

VIII. Authorized Official

Name: SUE R PONCE (AKA CARLSON)
Title or Position: SPECIAL PROJECTS
Credential:
Phone: 562-698-0811