Healthcare Provider Details

I. General information

NPI: 1699254052
Provider Name (Legal Business Name): RACHEL LEA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BON AIR RD STE 100
LARKSPUR CA
94939-1144
US

IV. Provider business mailing address

9300 CAMPUS POINT DR # 7892
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-0666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: