Healthcare Provider Details

I. General information

NPI: 1558192526
Provider Name (Legal Business Name): JESSICA K WHINERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N TUSTIN ST
ORANGE CA
92867-5958
US

IV. Provider business mailing address

155 YALE LN
SEAL BEACH CA
90740-2521
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-9555
  • Fax: 714-793-6908
Mailing address:
  • Phone: 562-753-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: