Provider Demographics
NPI:1477516409
Name:WHITING, TERRI M (PA)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:M
Last Name:WHITING
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:23170 HARBOR SEAL CT
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7956
Mailing Address - Country:US
Mailing Address - Phone:951-796-3536
Mailing Address - Fax:
Practice Address - Street 1:28636 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE #200
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2712
Practice Address - Country:US
Practice Address - Phone:951-678-9152
Practice Address - Fax:951-678-9152
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGX769ZMedicare PIN