Basic Information
| Provider Information | |||||||||
| NPI: | 1881695567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 N FAIRVIEW ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148358501 | ||||||||
| FaxNumber: | 7148353912 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 N FAIRVIEW ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148358501 | ||||||||
| FaxNumber: | 7148353912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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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 | G48409 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | G48409 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G484090 | 01 | CA | MEDI CAL | OTHER |