Provider Demographics
NPI:1205162740
Name:WHITING, EDITH VIRGINIA (MT)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:VIRGINIA
Last Name:WHITING
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 1:23 SARACENO
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1305
Mailing Address - Country:US
Mailing Address - Phone:949-689-3941
Mailing Address - Fax:
Practice Address - Street 1:23 SARACENO
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1305
Practice Address - Country:US
Practice Address - Phone:949-689-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA 22170246RM2200X
FLTN38921246RM2200X
HI4353246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory