Healthcare Provider Details

I. General information

NPI: 1285993667
Provider Name (Legal Business Name): VINCENT PATRICK WHELAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST FL 6
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

155 N FRESNO ST #226
FRESNO CA
93701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA131029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: