Provider Demographics
NPI:1033569421
Name:WHITE, ANNIE P (MSTOM, LAC)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:P
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 ROCKY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-6618
Mailing Address - Country:US
Mailing Address - Phone:203-814-8331
Mailing Address - Fax:
Practice Address - Street 1:9830 ROCKY RIDGE RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-6618
Practice Address - Country:US
Practice Address - Phone:203-814-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist