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General NPI Number Information
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NPI Number | 1508878935
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Entity Type | Individual
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Provider Name | JEANETTE R WHITE
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 5 BON AIR ROAD, STE. 105
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City | LARKSPUR
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State | CA
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Zip | 94939
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Country | US
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Telephone | 415-461-0440
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Fax | 415-461-3792
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Provider Business Mailing Address
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Address Line | 5 BON AIR ROAD, STE. 105
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City | LARKSPUR
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State | CA
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Zip | 94939
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Country | US
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Telephone | 415-461-0440
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Fax | 415-461-3792
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | D55471
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C54743
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License Number State | CA
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