Provider Demographics
NPI:1710911409
Name:DR. SUZANNE J WHITE
Entity Type:Organization
Organization Name:DR. SUZANNE J WHITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-827-1440
Mailing Address - Street 1:285 MERCEY SPRINGS RD
Mailing Address - Street 2:STE D
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3878
Mailing Address - Country:US
Mailing Address - Phone:209-827-1440
Mailing Address - Fax:
Practice Address - Street 1:285 MERCEY SPRINGS RD
Practice Address - Street 2:STE D
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3878
Practice Address - Country:US
Practice Address - Phone:209-827-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64192261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641920Medicaid
CAH152220Medicare UPIN
CA00A641921Medicare ID - Type Unspecified