Individual
ANGELA BROAD WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
167 N MAIN ST, TUBA CITY, AZ 86045-0600
(928) 283-2501
Mailing address
1411 E 31ST ST, QIC 22123, OAKLAND, CA 94602-1018
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A159782
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2017
Last updated
02/18/2022
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