Healthcare Provider Details

I. General information

NPI: 1962926402
Provider Name (Legal Business Name): ANGELLA LEONIE WHITE RN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 COLORADO AVE
RIVERSIDE CA
92503-2108
US

IV. Provider business mailing address

8805 COLORADO AVE
RIVERSIDE CA
92503-2108
US

V. Phone/Fax

Practice location:
  • Phone: 951-258-0272
  • Fax:
Mailing address:
  • Phone: 951-258-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number760036
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number760036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: