1427221860 NPI number — MISS DESDEMONIA LATRESE WHITTLE MFT

Table of content: MISS DESDEMONIA LATRESE WHITTLE MFT (NPI 1427221860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427221860 NPI number — MISS DESDEMONIA LATRESE WHITTLE MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITTLE
Provider First Name:
DESDEMONIA
Provider Middle Name:
LATRESE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

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:
1427221860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
459 FULTON #105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94102-4364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-267-4850
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
399 ARGUELLO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-6023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-267-4850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2008

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: 106H00000X , with the licence number:  MFC 43971 , 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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