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General NPI Number Information
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NPI Number | 1053179911
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Entity Type | Organization
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Legal Business Name | WHITEHEAD FAMILY WELLNESS CLINIC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 12813 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90061-2731
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Country | US
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Telephone | 310-819-8310
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Fax | 310-819-8178
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Provider Business Mailing Address
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Address Line | 12813 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90061-2731
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Country | US
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Telephone | 310-819-8310
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Fax | 310-819-8178
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | AURELIA WHITEHEAD
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Credential | FNP
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Telephone | 323-200-6418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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