Provider Demographics
NPI:1023399276
Name:WHITAKER, RICHARD NEWMAN (AUD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NEWMAN
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8283 GROVE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3137
Mailing Address - Country:US
Mailing Address - Phone:909-920-9906
Mailing Address - Fax:909-920-4151
Practice Address - Street 1:8283 GROVE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3137
Practice Address - Country:US
Practice Address - Phone:909-920-9906
Practice Address - Fax:909-920-4151
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2798237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter