Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A39975 | CA |
NPI | 1336170877 |
---|---|
Provider Name | Marvin White |
First Address | Inglewood, CA 90303-2336 |
Second Address | Inglewood, CA 90303-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 13/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E56880 | (02) | CA |