1811861941 NPI number — MR. DEREK EDWARD WHITTINGTON CATC IV

Table of content: MR. DEREK EDWARD WHITTINGTON CATC IV (NPI 1811861941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811861941 NPI number — MR. DEREK EDWARD WHITTINGTON CATC IV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTINGTON
Provider First Name:
DEREK
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CATC IV
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811861941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 CHETWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETALUMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94952-5205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-317-3900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 CLEVELAND AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95403-2788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-308-4492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  2114626 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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