Provider Demographics
NPI:1821737453
Name:R ANTONIO WHITELEY ACUPUNCTURE INC
Entity Type:Organization
Organization Name:R ANTONIO WHITELEY ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:R ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITELEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-890-6959
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568670289OtherNPI