MEDICARE: ANGELLA LEONIE WHITE RN,CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	760036	CA
2	163W00000X	Registered Nurse	760036	CA

General Provider Information

NPI Number	:	1962926402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELLA LEONIE WHITE RN,CDE

Provider Business Mailing Address
First Line	:	8805 COLORADO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-2108
Country	:	US
Telephone Number	:	951-258-0272
Fax Number	:

Provider Business Practice Location Address
First Line	:	8805 COLORADO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-2108
Country	:	US
Telephone Number	:	951-258-0272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	07/23/2024

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