1417170044 NPI number — DR. NICHOLAS TOTH MD

Table of content: DR. NICHOLAS TOTH MD (NPI 1417170044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417170044 NPI number — DR. NICHOLAS TOTH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOTH
Provider First Name:
NICHOLAS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1417170044
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:
2600 BAYVIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMEDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94501-6344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-521-7398
Provider Business Mailing Address Fax Number:
510-568-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24100 AMADOR
Provider Second Line Business Practice Location Address:
SUITE 250 WINTON WELLNESS CENTER
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-266-1700
Provider Business Practice Location Address Fax Number:
510-266-1762
Provider Enumeration Date:
04/11/2007

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: 207Q00000X , with the licence number:  G9054 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G9054 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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