Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 35127570 | OH |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A114996 | CA |
NPI | 1700111887 |
---|---|
Provider Name | Dr. Amanda Tencza Whitaker |
First Address | Sacramento, CA 95817-2307 |
Second Address | Sacramento, CA 95817-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7311323 | (05) | OH |