Provider Demographics
NPI:1194818252
Name:WHITEMAN, NEYSA DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:NEYSA
Middle Name:DALE
Last Name:WHITEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:SUITE C 302
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-943-1011
Mailing Address - Fax:760-943-1099
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:SUITE C 302
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-943-1011
Practice Address - Fax:760-943-1099
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42741207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42741Medicare ID - Type Unspecified
A49094Medicare UPIN