Provider Demographics
NPI:1295154326
Name:WHITE, ISAAC PHILLIPS (HEARING AID DISPENSE)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:PHILLIPS
Last Name:WHITE
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 W. STOCKTON BLVD
Mailing Address - Street 2:#103
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-627-1494
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:9300 W. STOCKTON BLVD
Practice Address - Street 2:STE 103
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-627-1494
Practice Address - Fax:916-773-9150
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7877237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist