Dwayne Raynard White

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

786 Brookhurst Blvd
Lathrop, CA 95330-8984

Phone

(209) 983-8633

NPI assigned

Nov 17, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lift Up Your Head Therapeutic Group Homes, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Lathrop, CA
  • NPI 1972191385
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1548979552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "786 BROOKHURST BLVD",
            "city": "LATHROP",
            "state": "CA",
            "postal_code": "953308984",
            "telephone_number": "209-983-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "786 BROOKHURST BLVD",
            "city": "LATHROP",
            "state": "CA",
            "postal_code": "953308984",
            "telephone_number": "209-983-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "DWAYNE",
        "middle_name": "RAYNARD",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-17",
        "last_updated": "2022-11-17",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Lee Venzke
• Deylanie Vongdeng
• Walgreen Co
• Julie Njeri Wanjohi
• Marissa M Wen, MD
• Julie Ann Williams
• Amber Wilson, LMFT
• Ana Maria Yerena
• Yvette Young, MS, CCC-SLP

• All providers in Lathrop, CA
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.