Healthcare Provider Details

I. General information

NPI: 1689538647
Provider Name (Legal Business Name): JACOB WHITE PMNHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 710
WOODLAND HILLS CA
91367-4976
US

IV. Provider business mailing address

21600 OXNARD ST STE 710
WOODLAND HILLS CA
91367-4976
US

V. Phone/Fax

Practice location:
  • Phone: 818-321-8428
  • Fax:
Mailing address:
  • Phone: 818-321-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95255203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: