Healthcare Provider Details

I. General information

NPI: 1871907105
Provider Name (Legal Business Name): STEPHEN E. WHITE P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660
US

IV. Provider business mailing address

1975 SHERINGTON PL APT H112
NEWPORT BEACH CA
92663-6090
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-5017
  • Fax: 949-432-3354
Mailing address:
  • Phone: 401-523-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004697
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031038
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0005385
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC05385
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: