Healthcare Provider Details

I. General information

NPI: 1619565660
Provider Name (Legal Business Name): DAHLIA WHITLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4995 CURRY DR
SAN DIEGO CA
92115-2631
US

IV. Provider business mailing address

10750 COLUMBIA PIKE # 401
SILVER SPRING MD
20901-4402
US

V. Phone/Fax

Practice location:
  • Phone: 916-300-9769
  • Fax:
Mailing address:
  • Phone: 301-593-6072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR278322
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: