Healthcare Provider Details

I. General information

NPI: 1831637057
Provider Name (Legal Business Name): TANISHA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LONG BEACH BLVD STE 322-6
LONG BEACH CA
90807-3346
US

IV. Provider business mailing address

PO BOX 135
LONG BEACH CA
90801-0135
US

V. Phone/Fax

Practice location:
  • Phone: 714-684-1255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number142024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: