Provider Demographics
NPI:1518518018
Name:WHITE, CAROLYN FRANCES
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:FRANCES
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4288 ARGUELLO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1506
Mailing Address - Country:US
Mailing Address - Phone:619-838-7211
Mailing Address - Fax:
Practice Address - Street 1:4288 ARGUELLO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1506
Practice Address - Country:US
Practice Address - Phone:619-838-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE0097730OtherDRIVER'S LICENSE