MEDICARE: QUENTIN WHITMORE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1720408438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUENTIN WHITMORE

Provider Business Mailing Address
First Line	:	600 E 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90021-1436
Country	:	US
Telephone Number	:	213-537-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E 7TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90021-1436
Country	:	US
Telephone Number	:	213-537-0110
Fax Number	:

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

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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Directions to “ QUENTIN WHITMORE ” Practice Location

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