Provider Demographics
NPI:1548316185
Name:WHITE, RODNEY (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-8765
Mailing Address - Fax:562-933-8766
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-8765
Practice Address - Fax:562-933-8766
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG299672086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G299670Medicaid
CAA91252Medicare UPIN
CAWG29967FMedicare ID - Type UnspecifiedPPIN
CAWG29967EMedicare ID - Type UnspecifiedPPIN
CAWG29967GMedicare ID - Type UnspecifiedPPIN