Provider Demographics
NPI:1902844103
Name:PERSONAL HEALTHCARE
Entity Type:Organization
Organization Name:PERSONAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-650-5353
Mailing Address - Street 1:17 CORPORATE PLAZA DR
Mailing Address - Street 2:110
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7902
Mailing Address - Country:US
Mailing Address - Phone:949-706-3300
Mailing Address - Fax:949-706-3301
Practice Address - Street 1:17 CORPORATE PLAZA DR
Practice Address - Street 2:110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7902
Practice Address - Country:US
Practice Address - Phone:949-706-3300
Practice Address - Fax:949-706-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73987Medicare UPIN