Provider Demographics
NPI:1558499392
Name:WHITTAKER, THERESA
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 E. HUNTINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010
Mailing Address - Country:US
Mailing Address - Phone:626-263-9133
Mailing Address - Fax:626-228-8102
Practice Address - Street 1:2502 E. HUNTINGTON DR.
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-263-9133
Practice Address - Fax:626-228-8102
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator