=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679789374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHELCO MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 08/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 BRAZOS ST SUITE H
-----------------------------------------------------
City | RAMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92065-1888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-789-7714
-----------------------------------------------------
Fax | 760-789-9366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 500528
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92150-0528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-789-7714
-----------------------------------------------------
Fax | 760-789-9366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DANIEL ROBERT WHELEHON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-789-7714
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 103731
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------