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General NPI Number Information
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NPI Number | 1104796341
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Entity Type | Individual
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Provider Name | MARIA WHITEHEAD
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Gender | Female
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 3594 4TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-4989
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Country | US
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Telephone | 619-296-1151
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Fax | 619-296-6218
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Provider Business Mailing Address
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Address Line | 2180 TREVI CIR
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City | CHULA VISTA
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State | CA
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Zip | 91913-3771
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Country | US
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Telephone | 619-776-4608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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