Provider Demographics
NPI:1023793999
Name:WHITE, DAVION (MA, ATC, PES, CES)
Entity type:Individual
Prefix:
First Name:DAVION
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MA, ATC, PES, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ROSECRANS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2451
Mailing Address - Country:US
Mailing Address - Phone:310-726-0750
Mailing Address - Fax:310-726-0752
Practice Address - Street 1:1600 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2017
Practice Address - Country:US
Practice Address - Phone:526-591-0581
Practice Address - Fax:562-591-0631
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0404021692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer