Provider Demographics
NPI:1699121491
Name:WHITAKER, ANGELA (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 TALBERT AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-965-2500
Mailing Address - Fax:714-965-2583
Practice Address - Street 1:9900 TALBERT AVE STE 301
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-965-2500
Practice Address - Fax:714-965-2583
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine