Provider Demographics
NPI:1891020574
Name:WHITTINGTON, LAURA (MT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 GARNET AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3352
Mailing Address - Country:US
Mailing Address - Phone:858-274-8888
Mailing Address - Fax:858-220-7526
Practice Address - Street 1:1816 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3352
Practice Address - Country:US
Practice Address - Phone:858-274-8888
Practice Address - Fax:858-220-7526
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMAS9712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist