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General NPI Number Information
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NPI Number | 1144923806
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Entity Type | Individual
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Provider Name | ASHLYN WHITTAKER
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Gender | Female
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1805 MEDICAL CENTER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1214
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Country | US
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Telephone | 909-806-1534
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Fax |
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Provider Business Mailing Address
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Address Line | 731 SILVERWOOD PL
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City | REDLANDS
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State | CA
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Zip | 92373-5657
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Country | US
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Telephone | 501-516-5671
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA66394
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | PA.0007937
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | PA66394
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License Number State | CA
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