Healthcare Provider Details

I. General information

NPI: 1528990173
Provider Name (Legal Business Name): CHARLES RAY WHITE PHD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3764 PACIFIC AVE
RIVERSIDE CA
92509-4211
US

IV. Provider business mailing address

53 GLACIER VLY
IRVINE CA
92602-1862
US

V. Phone/Fax

Practice location:
  • Phone: 808-491-1111
  • Fax:
Mailing address:
  • Phone: 909-528-0192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: