Healthcare Provider Details

I. General information

NPI: 1720801426
Provider Name (Legal Business Name): DR. WHITNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S ELENA AVE STE H
REDONDO BEACH CA
90277-5700
US

IV. Provider business mailing address

1820 S ELENA AVE STE H
REDONDO BEACH CA
90277-5700
US

V. Phone/Fax

Practice location:
  • Phone: 310-489-3304
  • Fax:
Mailing address:
  • Phone: 310-489-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY PAULLIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 310-489-3304