Healthcare Provider Details

I. General information

NPI: 1770476756
Provider Name (Legal Business Name): CHASE WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 SUNRISE AVE STE 300
ROSEVILLE CA
95661-4144
US

IV. Provider business mailing address

300 CIRBY HILLS DR APT 257
ROSEVILLE CA
95678-4366
US

V. Phone/Fax

Practice location:
  • Phone: 916-783-5207
  • Fax:
Mailing address:
  • Phone: 559-542-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: