Healthcare Provider Details

I. General information

NPI: 1093116485
Provider Name (Legal Business Name): CALI WHITE M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STANDISH AVE
SANTA ROSA CA
95407-8113
US

IV. Provider business mailing address

3650 STANDISH AVE
SANTA ROSA CA
95407-8113
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-6108
  • Fax:
Mailing address:
  • Phone: 707-585-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: