Provider Demographics
NPI:1033793948
Name:WHITE, ERIC ALLAN
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALLAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 G ST
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1949
Mailing Address - Country:US
Mailing Address - Phone:209-251-7461
Mailing Address - Fax:209-912-4036
Practice Address - Street 1:511 G ST
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1949
Practice Address - Country:US
Practice Address - Phone:209-251-7461
Practice Address - Fax:209-912-4036
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
CA3427010183747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion