Provider Demographics
NPI:1083646202
Name:YOLANDA DUARTE-WHITE PROVISION SUPPLIES
Entity Type:Organization
Organization Name:YOLANDA DUARTE-WHITE PROVISION SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-695-8115
Mailing Address - Street 1:749 CLELA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3106
Mailing Address - Country:US
Mailing Address - Phone:626-826-3112
Mailing Address - Fax:323-268-1485
Practice Address - Street 1:12221 HADLEY ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-3914
Practice Address - Country:US
Practice Address - Phone:562-695-8115
Practice Address - Fax:562-695-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103861332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies