Provider Demographics
NPI:1043742174
Name:WHITE, GENA (RADT I)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RADT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23452 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2511
Mailing Address - Country:US
Mailing Address - Phone:661-755-4341
Mailing Address - Fax:
Practice Address - Street 1:23452 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2511
Practice Address - Country:US
Practice Address - Phone:661-755-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner