1104939974 NPI number — MR. KEN HOWAT MS ATC

Table of content: MR. KEN HOWAT MS ATC (NPI 1104939974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104939974 NPI number — MR. KEN HOWAT MS ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWAT
Provider First Name:
KEN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104939974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 PATCH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93933-5035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-884-9358
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CAMPUS CTR
Provider Second Line Business Practice Location Address:
ATHLETIC TRAINING ROOM, BLDG 90
Provider Business Practice Location Address City Name:
SEASIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93955-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-582-3010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)