Healthcare Provider Details

I. General information

NPI: 1285628669
Provider Name (Legal Business Name): PAUL MICHAEL WHYTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 ALAMO ST. SUITE 100
SIMI VALLEY CA
93065-1345
US

IV. Provider business mailing address

2755 ALAMO ST. SUITE 100
SIMI VALLEY CA
93065-1345
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-7280
  • Fax: 805-210-7281
Mailing address:
  • Phone: 805-210-7280
  • Fax: 805-210-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG34659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: