Provider Demographics
NPI:1194842625
Name:WHYTE, ROGELIO LEONARDO (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGELIO
Middle Name:LEONARDO
Last Name:WHYTE
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 1:595 EAST COLORADO BLVD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2039
Mailing Address - Country:US
Mailing Address - Phone:626-440-1911
Mailing Address - Fax:626-332-6587
Practice Address - Street 1:595 EAST COLORADO BLVD
Practice Address - Street 2:SUITE 507
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-440-1911
Practice Address - Fax:626-332-6587
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC397172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C397170Medicaid
CA00C397170Medicaid
C39717Medicare ID - Type Unspecified