Provider Demographics
NPI:1780015867
Name:WHITE, HOWARD
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3697
Mailing Address - Country:US
Mailing Address - Phone:909-932-1069
Mailing Address - Fax:909-932-1087
Practice Address - Street 1:916 N MOUNTAIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3697
Practice Address - Country:US
Practice Address - Phone:909-932-1069
Practice Address - Fax:909-932-1087
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker