Provider Demographics
NPI:1164630455
Name:WHITE, DAVID A (BS, MS IN ED)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:BS, MS IN ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 VIA BLANCA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-7345
Mailing Address - Country:US
Mailing Address - Phone:760-529-0499
Mailing Address - Fax:
Practice Address - Street 1:2821 OCEANSIDE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4800
Practice Address - Country:US
Practice Address - Phone:760-721-2781
Practice Address - Fax:760-721-9571
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3525OtherCAS REGISTATION