MEDICARE: MISS KATRINA MANJA WHALEN ACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	22279	CA
2	363LA2100X	Acute Care Nurse Practitioner	22279	CA

General Provider Information

NPI Number	:	1437491966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATRINA MANJA WHALEN ACNP-BC

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MEDICAL PLAZA
Second Line	:	SUITE 700
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-825-9111
Fax Number	:	424-465-6189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	02/10/2026

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