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General NPI Number Information
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NPI Number | 1023151040
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Entity Type | Organization
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Legal Business Name | WHITTIER FETTERLY MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 4762 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3026
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Country | US
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Telephone | 323-269-4060
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Fax | 323-269-5284
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Provider Business Mailing Address
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Address Line | 4762 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-3026
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Country | US
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Telephone | 323-269-4060
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Fax | 323-269-5284
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JUAN C RAMIREZ
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Credential | M.D.
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Telephone | 323-269-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A90483
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License Number State | CA
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