Healthcare Provider Details

I. General information

NPI: 1477572048
Provider Name (Legal Business Name): LAURA F WHITTEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 GREGORY LANE SUITE 203
PLESANT HILL CA
94523
US

IV. Provider business mailing address

132 YALE AVE
MILL VALLEY CA
94941-3531
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3600
  • Fax:
Mailing address:
  • Phone: 415-383-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberG23556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: