Healthcare Provider Details

I. General information

NPI: 1679760003
Provider Name (Legal Business Name): DAVID B. WHITEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11693 SAN VICENTE BLVD # 456
LOS ANGELES CA
90049-5105
US

IV. Provider business mailing address

11693 SAN VICENTE BLVD # 456
LOS ANGELES CA
90049-5105
US

V. Phone/Fax

Practice location:
  • Phone: 818-305-4332
  • Fax:
Mailing address:
  • Phone: 818-305-4332
  • Fax: 818-789-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberG70906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: