Provider Demographics
NPI:1104796341
Name:WHITEHEAD, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 TREVI CIR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3771
Mailing Address - Country:US
Mailing Address - Phone:619-776-4608
Mailing Address - Fax:
Practice Address - Street 1:3594 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4989
Practice Address - Country:US
Practice Address - Phone:619-296-1151
Practice Address - Fax:619-296-6218
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-11
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist