Healthcare Provider Details

I. General information

NPI: 1457873291
Provider Name (Legal Business Name): DANIEL ELLSWORTH WHITE III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 ENCINITAS BLVD STE A
ENCINITAS CA
92024-2845
US

IV. Provider business mailing address

1351 ENCINITAS BLVD SUITE A
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-3321
  • Fax:
Mailing address:
  • Phone: 760-942-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: