Healthcare Provider Details

I. General information

NPI: 1134709082
Provider Name (Legal Business Name): NICHOLAS MICHAEL WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 GAYLEY AVE STE 201
LOS ANGELES CA
90024-3426
US

IV. Provider business mailing address

1033 GAYLEY AVE STE 201
LOS ANGELES CA
90024-3426
US

V. Phone/Fax

Practice location:
  • Phone: 310-426-8381
  • Fax: 310-496-7275
Mailing address:
  • Phone: 310-426-8381
  • Fax: 310-496-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA184685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: