Healthcare Provider Details

I. General information

NPI: 1619005485
Provider Name (Legal Business Name): ANTHONY HOWARD WHITE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 ROSEVILLE RD STE 107
NORTH HIGHLANDS CA
95660-5175
US

IV. Provider business mailing address

7523 ISLAND WAY
SACRAMENTO CA
95831-3795
US

V. Phone/Fax

Practice location:
  • Phone: 916-344-0199
  • Fax:
Mailing address:
  • Phone: 916-393-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: