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NPI Code Detail

MEDICARE: DEBORAH LYNN WHITE PA

MEDICARE:   DEBORAH LYNN WHITE  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA17670CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA17670OTHERCALICENSE

General Provider Information

NPI Number : 1417165978
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH LYNN WHITE PA
Provider Business Mailing Address
First Line : DEPT LA21190
Second Line :
City : PASADENA
State : CA
Zip : 91185-1190
Country : US
Telephone Number : 714-449-4800
Fax Number : 714-449-4956
Provider Business Practice Location Address
First Line : 1514 VALLEY VISTA DR
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-3929
Country : US
Telephone Number : 909-860-1144
Fax Number : 909-860-8307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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Directions to “ DEBORAH LYNN WHITE PA” Practice Location

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