# WHITEHEAD FAMILY WELLNESS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053179911
- **Authorized official:** AURELIA WHITEHEAD FNP (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (323) 200-6418

## Contact information

- **Practice address:** 12813 AVALON BLVD, LOS ANGELES, CA 90061-2731
- **Practice address phone:** (310) 819-8310
- **Practice address fax:** (310) 819-8178
- **Mailing address:** 12813 AVALON BLVD, LOS ANGELES, CA 90061-2731
- **Mailing address phone:** (310) 819-8310
- **Mailing address fax:** (310) 819-8178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |

## Other

- **Enumeration date:** 03/06/2024
- **Last updated:** 03/06/2024