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General NPI Number Information
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NPI Number | 1336404599
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Entity Type | Individual
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Provider Name | JOHN RICHARD WHITE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 4400 PALOS VERDES DR E
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6474
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Country | US
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Telephone | 310-833-3790
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Fax | 310-833-3748
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Provider Business Mailing Address
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Address Line | 4400 PALOS VERDES DR E
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6474
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Country | US
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Telephone | 310-833-3790
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Fax | 310-833-3748
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | M6588
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207UN0902X
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Taxonomy Name | Nuclear Imaging & Therapy Physician
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License Number | CFE23483
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License Number State | CA
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