Basic Information
| Provider Information | |||||||||
| NPI: | 1700841707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITLEY | ||||||||
| FirstName: | CAREEN | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARTER | ||||||||
| OtherFirstName: | CAREEN | ||||||||
| OtherMiddleName: | WHITLEY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104190230 | ||||||||
| FaxNumber: | 5104190273 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104190230 | ||||||||
| FaxNumber: | 5104190273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OOG533030 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207VX0000X | OOG533030 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | AW2374231 | 01 | CA | DEA | OTHER |