Healthcare Provider Details

I. General information

NPI: 1548031784
Provider Name (Legal Business Name): DEJA AMAN WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CITRACADO PKWY STE 300
ESCONDIDO CA
92029-4113
US

IV. Provider business mailing address

2779 W CANYON AVE APT 233
SAN DIEGO CA
92123-4727
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-1281
  • Fax:
Mailing address:
  • Phone: 909-746-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3632706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: