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General NPI Number Information
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NPI Number | 1285049056
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Entity Type | Individual
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Provider Name | DORRIAN WHITE
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Gender | Male
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 4325 W ROME BLVD APT 1050
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-5403
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Country | US
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Telephone | 702-237-8063
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 W ROME BLVD APT 1050
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89084-5403
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Country | US
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Telephone | 702-237-8063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | 5341-C
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License Number State | NV
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