MEDICARE: M JODY WHITEHOUSE MD

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	2084P0800X	Psychiatry Physician	G154176	CA

General Provider Information

NPI Number	:	1700904174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M JODY WHITEHOUSE MD

Provider Business Mailing Address
First Line	:	1510 S VIEW POINT ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035
Country	:	US
Telephone Number	:	215-519-7357
Fax Number	:	310-974-4972

Provider Business Practice Location Address
First Line	:	1510 S VIEW POINT ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035
Country	:	US
Telephone Number	:	215-519-7357
Fax Number	:	310-974-4972

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	01/09/2026

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