Healthcare Provider Details

I. General information

NPI: 1457597247
Provider Name (Legal Business Name): NATASHA DENISE WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2008
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 UNIVERSITY AVE STE 100
RIVERSIDE CA
92507-5364
US

IV. Provider business mailing address

1744 UNIVERSITY AVE STE 100
RIVERSIDE CA
92507-5364
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-2106
  • Fax: 951-683-2105
Mailing address:
  • Phone: 951-683-2106
  • Fax: 951-683-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: