Basic Information
| Provider Information | |||||||||
| NPI: | 1083664841 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIH HEALTH WHITTIER HOSPITAL | ||||||||
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| OtherOrganizationName: | PRESBYTERIAN INTERCOMMUNITY HOSPITAL, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1277 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906091277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627895401 | ||||||||
| FaxNumber: | 5627895912 | ||||||||
| Practice Location | |||||||||
| Address1: | 12291 WASHINGTON BLVD | ||||||||
| Address2: | 500 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626982541 | ||||||||
| FaxNumber: | 5626980010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | PONCE (AKA CARLSON) | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | SPECIAL PROJECTS | ||||||||
| AuthorizedOfficialTelephone: | 5626980811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A52601 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.