Organization
WHITAKER WELLNESS INSTITUTE MEDICAL CLINIC INC
Active
Parent organization
WHITAKER WELLNESS INSTITUTE MEDICAL CLINIC INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WHITAKER WELLNESS INSTITUTE MEDICAL CLINIC INC
Authorized official
DR. JULIAN WHITAKER MD (LABORATORY DIRECTOR)
(949) 851-1550
Entity
Organization
Contact information
Practice address
4321 BIRCH ST, SUITE 100, NEWPORT BEACH, CA 92660-1923
(949) 851-1550
Mailing address
4321 BIRCH ST, SUITE 100, NEWPORT BEACH, CA 92660-1923
(949) 851-1550
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 11147
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CLF 11147
DEPARTMENT OF HEALTH SERVICES
CA
Enumeration date
08/28/2008
Last updated
10/28/2008
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