Healthcare Provider Details

I. General information

NPI: 1447814876
Provider Name (Legal Business Name): MARIELA G WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SEASONS RD STE 300
CUYAHOGA FALLS OH
44224-1069
US

IV. Provider business mailing address

231 SEASONS RD STE 300
CUYAHOGA FALLS OH
44224-1069
US

V. Phone/Fax

Practice location:
  • Phone: 303-662-5666
  • Fax:
Mailing address:
  • Phone: 303-662-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.144173
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: