Provider Demographics
NPI:1568670289
Name:WHITELEY, R. ANTONIO (LAC)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:ANTONIO
Last Name:WHITELEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 BEVERLY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2671
Mailing Address - Country:US
Mailing Address - Phone:310-890-6959
Mailing Address - Fax:310-388-0171
Practice Address - Street 1:8315 BEVERLY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-2671
Practice Address - Country:US
Practice Address - Phone:310-890-6959
Practice Address - Fax:310-388-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11735171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist