Provider Demographics
NPI:1629087887
Name:WHITE, DAVID M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10444 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5057
Mailing Address - Country:US
Mailing Address - Phone:310-390-5306
Mailing Address - Fax:310-441-9343
Practice Address - Street 1:10444 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5057
Practice Address - Country:US
Practice Address - Phone:310-390-5306
Practice Address - Fax:310-441-9343
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12192103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY121920Medicaid
CAPSY121920Medicaid
CAR27469Medicare UPIN