Provider Demographics
NPI:1912229808
Name:BURRELL, WHITNEY ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ALEXIS
Last Name:BURRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 LOMITA BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3904
Mailing Address - Country:US
Mailing Address - Phone:310-784-0644
Mailing Address - Fax:310-784-0544
Practice Address - Street 1:3640 LOMITA BLVD STE 306
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3904
Practice Address - Country:US
Practice Address - Phone:310-784-0644
Practice Address - Fax:310-784-0544
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1215028208200000X
CAA125028208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty