Provider Demographics
NPI:1588134480
Name:WHITE, CAROLINA (LPT)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:AQUINO-OLIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1136 SILVERTRAIL LN
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3013
Mailing Address - Country:US
Mailing Address - Phone:209-481-6175
Mailing Address - Fax:
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41058167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes167G00000XNursing Service ProvidersLicensed Psychiatric TechnicianGroup - Single Specialty