Provider Demographics
NPI:1700841707
Name:WHITLEY, CAREEN RENE (MD)
Entity Type:Individual
Prefix:
First Name:CAREEN
Middle Name:RENE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAREEN
Other - Middle Name:WHITLEY
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3425
Mailing Address - Country:US
Mailing Address - Phone:510-419-0230
Mailing Address - Fax:510-419-0273
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3425
Practice Address - Country:US
Practice Address - Phone:510-419-0230
Practice Address - Fax:510-419-0273
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOOG533030207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW2374231OtherDEA
A52488Medicare UPIN
CAMMM00345MMedicare ID - Type Unspecified