Healthcare Provider Details

I. General information

NPI: 1447668512
Provider Name (Legal Business Name): ANDREW JAMES WHITE DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

200 W ARBOR DR
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-7447
  • Fax: 858-552-4311
Mailing address:
  • Phone: 858-552-7447
  • Fax: 858-552-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000977
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95000977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: