Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | M6588 | ID |
NPI | 1336404599 |
---|---|
Provider Name | Dr. John Richard White |
First Address | Rancho Palos Verdes, CA 90275-6474 |
Second Address | Rancho Palos Verdes, CA 90275-6474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 12/07/2012 |