Healthcare Provider Details

I. General information

NPI: 1780145425
Provider Name (Legal Business Name): HERBERT WHITING VIRGIN-DOWNEY V MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 314-740-3990
  • Fax:
Mailing address:
  • Phone: 314-740-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberPTL1785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: