Basic Information
| Provider Information | |||||||||
| NPI: | 1548742083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITSETT | ||||||||
| FirstName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 W LA VETA AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145098481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18350 MOUNT LANGLEY ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927086912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1473782620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2018 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 31318 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.