Provider Demographics
NPI:1710211263
Name:WHITE, SCOTT ROBERT (LAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:WHITE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 MISSION ST
Mailing Address - Street 2:1
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3043
Mailing Address - Country:US
Mailing Address - Phone:626-372-3505
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:G
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3225
Practice Address - Country:US
Practice Address - Phone:626-372-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist